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General NPI Number Information
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NPI Number | 1124746664
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Entity Type | Individual
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Provider Name | KOKEYSHA R SMITH AG-ACNP
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Gender | Female
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 8200 WALNUT HILL LN
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City | DALLAS
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State | TX
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Zip | 75231-4402
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Country | US
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Telephone | 214-345-6789
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Fax |
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Provider Business Mailing Address
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Address Line | 4721 AUBURN RIDGE DR
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City | FORT WORTH
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State | TX
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Zip | 76123-4042
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Country | US
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Telephone | 817-614-1641
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1091098
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License Number State | TX
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