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NPI Code Detail

MEDICARE: BONNIE KELLAM SMITH WHCNP

MEDICARE: BONNIE KELLAM SMITH WHCNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse PractitionerAP103014TX
2163W00000XRegistered NurseRN452065TX
3163W00000XRegistered NurseRN112114LA
4363LW0102XWomen's Health Nurse PractitionerAP04701LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053518894
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE KELLAM SMITH WHCNP
Provider Business Mailing Address
First Line : 4600 GULF FWY
Second Line :
City : HOUSTON
State : TX
Zip : 77023-3548
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4600 GULF FWY
Second Line :
City : HOUSTON
State : TX
Zip : 77023-3548
Country : US
Telephone Number : 713-522-3976
Fax Number : 404-494-7435
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2007
Last Update Date : 09/13/2019

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