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1902626237 NPI number — CRYSTAL DENISE SMITH REGISTERED NURSE

NPI Number: 1902626237
Health Care Provider/Practitioner: CRYSTAL DENISE SMITH REGISTERED NURSE

Information about “1902626237” NPI (CRYSTAL DENISE SMITH REGISTERED NURSE) exists in 1902626237 in HTML format HTML  |  1902626237 in plain Text format TXT  |  1902626237 in PDF (Portable Document Format) PDF  |  1902626237 in an XML format XML  formats.

NPI Number : 1902626237 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902626237",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SMITH",
    "FirstName": "CRYSTAL",
    "MiddleName": "DENISE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "REGISTERED NURSE",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SMITH",
    "OtherFirstName": "CRYSTAL",
    "OtherMiddleName": "DENISE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "REGISTERED NURSE",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "203 N GRAND ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALEM",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65560-1344",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "203 N GRAND ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SALEM",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "65560-1344",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "573-218-2422",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/11/2024",
    "LastUpdateDate": "10/11/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "163WA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Registered Nurse",
        "LicenseNumber": "2024018507",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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