Healthcare Provider Details

I. General information

NPI: 1073272043
Provider Name (Legal Business Name): BLAIR ARTHUR SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 11TH ST
WICHITA FALLS TX
76301-4300
US

IV. Provider business mailing address

1631 11TH STREET UNIT B
WICHITA FALLS TX
76301-3415
US

V. Phone/Fax

Practice location:
  • Phone: 940-263-3000
  • Fax: 940-263-3018
Mailing address:
  • Phone: 940-263-3000
  • Fax: 940-263-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1094961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: