MEDICARE: STEPHEN SMITH

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
1	3747P1801X	Personal Care Attendant		TX
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care		TX

General Provider Information

NPI Number	:	1063347177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN SMITH

Provider Business Mailing Address
First Line	:	2404 BROWN DEER TRL
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-1447
Country	:	US
Telephone Number	:	469-367-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 BROWN DEER TRL
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-1447
Country	:	US
Telephone Number	:	469-367-2205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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Directions to “ STEPHEN SMITH ” Practice Location

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