1538681176 NPI number — MRS. HEATHER ROBERTSON SMITH CFNP

Table of content: MRS. HEATHER ROBERTSON SMITH CFNP (NPI 1538681176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538681176 NPI number — MRS. HEATHER ROBERTSON SMITH CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
HEATHER
Provider Middle Name:
ROBERTSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CFNP
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:
1538681176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 RED OAK TREE DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71343-5573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 SERIO BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERRIDAY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-757-0210
Provider Business Practice Location Address Fax Number:
318-757-9916
Provider Enumeration Date:
07/14/2017

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:  902020 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP09354 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 606760 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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