1295816536 NPI number — MS. CAROLYN H SMITH RNP

Table of content: MS. CAROLYN H SMITH RNP (NPI 1295816536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295816536 NPI number — MS. CAROLYN H SMITH RNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CAROLYN
Provider Middle Name:
H
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENDERSON
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295816536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3529 HIRONDELLE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORISSANT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63034-2221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-814-8585
Provider Business Mailing Address Fax Number:
314-814-8542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 BIDDLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63106-3454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-814-8585
Provider Business Practice Location Address Fax Number:
314-814-8542
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  082848 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4235666413 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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