MEDICARE: MRS. PATRICIA ANNE SMITH NURSE PRACTITIONER

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	163W00000X	Registered Nurse	564579	TX
2	363LF0000X	Family Nurse Practitioner	AP111039	TX

General Provider Information

NPI Number	:	1144228198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ANNE SMITH NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6915 WEST AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1822
Country	:	US
Telephone Number	:	210-341-1487
Fax Number	:

Provider Business Practice Location Address
First Line	:	6915 WEST AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1822
Country	:	US
Telephone Number	:	210-341-1487
Fax Number	:

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	01/01/2025

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