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NPI Code Detail

MEDICARE: MRS. STACEY DENISE SMITH PMHNP-BC

MEDICARE: MRS. STACEY DENISE SMITH PMHNP-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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1074508TX

General Provider Information

NPI Number : 1972249860
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACEY DENISE SMITH PMHNP-BC
Provider Business Mailing Address
First Line : 1216 PARKVIEW TRL
Second Line :
City : GLENN HEIGHTS
State : TX
Zip : 75154-8837
Country : US
Telephone Number : 214-455-9640
Fax Number :
Provider Business Practice Location Address
First Line : 4645 SAMUELL BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75228-6826
Country : US
Telephone Number : 214-743-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2022
Last Update Date : 12/08/2025

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