MEDICARE: JO ANNE SMITH FNP

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	674982	TX
2	363LP2300X	Primary Care Nurse Practitioner	AP122250	TX

General Provider Information

NPI Number	:	1821342411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO ANNE SMITH FNP

Provider Business Mailing Address
First Line	:	96 BERRY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3057
Country	:	US
Telephone Number	:	713-699-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-3428
Country	:	US
Telephone Number	:	361-552-4886
Fax Number	:	361-552-4896

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

Provider Enumeration Date	:	11/03/2012
Last Update Date	:	04/28/2021

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