Provider Demographics
NPI:1437148624
Name:SMITH, LAURA YVONNE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:YVONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 NANCY ELLEN ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6327
Mailing Address - Country:US
Mailing Address - Phone:806-731-4000
Mailing Address - Fax:877-460-4201
Practice Address - Street 1:6504 NANCY ELLEN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6327
Practice Address - Country:US
Practice Address - Phone:806-731-4000
Practice Address - Fax:877-460-4201
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121259363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200334300Medicaid
S98320Medicare UPIN
IN200334300Medicaid