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General NPI Number Information
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NPI Number | 1235804212
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Entity Type | Individual
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Provider Name | MICHAEL ALAN SMITH RN
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Gender | Male
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 100 N AVENUE D
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City | BURKBURNETT
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State | TX
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Zip | 76354-3509
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Country | US
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Telephone | 940-569-3381
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Fax | 940-569-2499
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Provider Business Mailing Address
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Address Line | 901 PARK PLAZA DR
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City | IOWA PARK
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State | TX
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Zip | 76367-1136
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Country | US
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Telephone | 817-925-0251
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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 | 163WN0003X
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Taxonomy Name | Low-Risk Neonatal Registered Nurse
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License Number | 869768
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 869768
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 869768
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License Number State | TX
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