Healthcare Provider Details

I. General information

NPI: 1326709825
Provider Name (Legal Business Name): RYAN D SMITH FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/08/2022
Certification Date: 01/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15069 IH 35 N STE 116
SELMA TX
78154-3372
US

IV. Provider business mailing address

14100 SAN PEDRO AVE STE 412
SAN ANTONIO TX
78232-2009
US

V. Phone/Fax

Practice location:
  • Phone: 210-656-4878
  • Fax:
Mailing address:
  • Phone: 210-281-8669
  • Fax: 210-314-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1060438
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: