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General NPI Number Information
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NPI Number | 1336701317
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Entity Type | Individual
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Provider Name | GREGORY N SMITH JR.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 2001 N JEFFERSON AVE STE 300
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City | MOUNT PLEASANT
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State | TX
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Zip | 75455-2375
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Country | US
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Telephone | 903-572-9823
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Fax |
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Provider Business Mailing Address
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Address Line | 1727 100TH ST
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City | LUBBOCK
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State | TX
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Zip | 79423-7145
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Country | US
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Telephone | 806-224-9589
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP141748
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License Number State | TX
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