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General NPI Number Information
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NPI Number | 1386407187
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Entity Type | Individual
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Provider Name | LEEZA CAROLINE SMITH FNP
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Gender | Female
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 1648 W HARPER ST STE 2
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-4110
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Country | US
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Telephone | 573-609-2203
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Fax |
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Provider Business Mailing Address
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Address Line | 14458 SPYGLASS PT
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City | DEXTER
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State | MO
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Zip | 63841-8334
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Country | US
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Telephone | 573-300-6608
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2023050148
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License Number State | MO
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