MEDICARE: ROBERT NATHAN SMITH NP

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	363LF0000X	Family Nurse Practitioner	SMIT-IY8V6O	MS

General Provider Information

NPI Number	:	1104430552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT NATHAN SMITH NP

Provider Business Mailing Address
First Line	:	13100 RIVER RD STE 100
Second Line	:
City	:	DESTREHAN
State	:	LA
Zip	:	70047-5216
Country	:	US
Telephone Number	:	985-235-0010
Fax Number	:	985-764-1310

Provider Business Practice Location Address
First Line	:	13100 RIVER RD STE 100
Second Line	:
City	:	DESTREHAN
State	:	LA
Zip	:	70047-5216
Country	:	US
Telephone Number	:	985-235-0010
Fax Number	:	985-764-1310

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

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	10/28/2024

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