=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841082120
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITALITY NP SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2025
-----------------------------------------------------
Last Update Date | 05/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 HIGHWAY 327 E
-----------------------------------------------------
City | SILSBEE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77656-5005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-658-8299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 LAURIE LN
-----------------------------------------------------
City | SILSBEE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77656-8936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-658-8299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NP-C
-----------------------------------------------------
Name | DR. SHAUNDE SMITH
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 409-658-8299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------