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General NPI Number Information
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NPI Number | 1962920785
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Entity Type | Individual
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Provider Name | DENISE R SMITH NP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 2025 VIRGINIA AVE., STE. D
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City | CONNERSVILLE
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State | IN
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Zip | 47331-2914
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Country | US
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Telephone | 765-827-8064
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Fax | 765-825-6999
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Provider Business Mailing Address
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Address Line | 1100 REID PARKWAY MEDICAL STAFF SERVICE
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City | RICHMOND
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State | IN
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Zip | 47374-1157
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Country | US
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Telephone | 765-935-8802
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Fax | 765-983-3219
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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 | 71007638A
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License Number State | IN
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