1427249457 NPI number — MS. FELECIA E SMITH FNP

Table of content: JORIANN LYNN MCGRATH (NPI 1104262310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427249457 NPI number — MS. FELECIA E SMITH FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
FELECIA
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427249457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8930 FOURWINDS DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDCREST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78239-1971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-902-9596
Provider Business Mailing Address Fax Number:
210-693-1491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8930 FOURWINDS DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDCREST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78239-1971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-590-5956
Provider Business Practice Location Address Fax Number:
210-693-1491
Provider Enumeration Date:
08/06/2007

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: 363LF0000X , with the licence number:  652895 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP116133 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01165933 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 272605YNVL . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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