MEDICARE: MS. CASSIE N SMITH FNP-BC

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	2015009964	MO

General Provider Information

NPI Number	:	1407243629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CASSIE N SMITH FNP-BC

Provider Business Mailing Address
First Line	:	425 S EUCLID AVE STE 2710
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1005
Country	:	US
Telephone Number	:	314-273-4850
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 S EUCLID AVE STE 2710
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1005
Country	:	US
Telephone Number	:	314-273-4850
Fax Number	:

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

Provider Enumeration Date	:	04/26/2015
Last Update Date	:	07/26/2021

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