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General NPI Number Information
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NPI Number | 1124650155
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Entity Type | Individual
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Provider Name | AUDRIANNA SHAUNTERA SMITH NP
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Gender | Female
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Dates
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Enumeration Date | 02/07/2020
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 1005 GROVE RD
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City | GREENVILLE
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State | SC
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Zip | 29605-4630
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Country | US
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Telephone | 864-455-6900
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Fax | 864-255-5619
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-695-6697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 5020019
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5020019
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 21701
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License Number State | SC
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