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General NPI Number Information
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NPI Number | 1669011300
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Entity Type | Individual
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Provider Name | ALEXA SMITH NP
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Gender | Female
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Dates
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Enumeration Date | 12/28/2019
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 2800 E BROAD ST #304
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone | 817-477-5500
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Fax | 817-453-5503
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Provider Business Mailing Address
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Address Line | 2800 E BROAD ST STE 304
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City | MANSFIELD
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State | TX
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Zip | 76063-6412
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Country | US
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Telephone | 817-477-5500
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Fax | 817-453-5503
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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 | AP143645
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License Number State | TX
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