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NPI Code Detail

MEDICARE: AUDRIANNA SHAUNTERA SMITH NP

MEDICARE: AUDRIANNA SHAUNTERA 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
1363LA2200XAdult Health Nurse Practitioner5020019NC
2363L00000XNurse Practitioner5020019NC
3363LG0600XGerontology Nurse Practitioner21701SC

General Provider Information

NPI Number : 1124650155
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDRIANNA SHAUNTERA SMITH NP
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number : 864-695-6697
Fax Number :
Provider Business Practice Location Address
First Line : 1005 GROVE RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29605-4630
Country : US
Telephone Number : 864-455-6900
Fax Number : 864-255-5619
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2020
Last Update Date : 02/09/2026

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Directions to “ AUDRIANNA SHAUNTERA SMITH NP” Practice Location

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