MEDICARE: MRS. HEATHER RENAE SMITH CRNA

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	367500000X	Certified Registered Nurse Anesthetist	1568	NC
2	367500000X	Certified Registered Nurse Anesthetist	085610	NC

General Provider Information

NPI Number	:	1528376738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER RENAE SMITH CRNA

Provider Business Mailing Address
First Line	:	210 BECKFORD DR
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27295-8799
Country	:	US
Telephone Number	:	336-247-3678
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-3069
Fax Number	:

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

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	12/08/2025

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