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General NPI Number Information
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NPI Number | 1659033736
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Entity Type | Individual
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Provider Name | BLAIR KENNEDY SMITH MSN, RN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 2449 HOSPITAL DR STE 200
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City | BOSSIER CITY
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State | LA
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Zip | 71111-1905
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Country | US
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Telephone | 318-212-7841
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Fax |
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Provider Business Mailing Address
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Address Line | 760 SOUTHERN TRACE PKWY
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City | SHREVEPORT
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State | LA
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Zip | 71106-9325
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Country | US
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Telephone | 318-230-4980
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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 | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 221579
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 221579
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 221579
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License Number State | LA
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