Healthcare Provider Details

I. General information

NPI: 1396656278
Provider Name (Legal Business Name): ALICIA SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1767 COUNTY ROAD 147
BURNS WY
82053-9707
US

IV. Provider business mailing address

1767 COUNTY ROAD 147
BURNS WY
82053-9707
US

V. Phone/Fax

Practice location:
  • Phone: 307-631-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number19024
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: