# AMITY LYNN SMITH, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revolution Wellness and Prevention
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114323987
- **Authorized official:** AMITY LYNN SMITH MD (OWNER)
- **Authorized official phone:** (817) 488-2837

## Contact information

- **Practice address:** 601 ZENA RUCKER RD, STE 105, SOUTHLAKE, TX 76092-6386
- **Practice address phone:** (817) 466-2837
- **Practice address fax:** (817) 488-6335
- **Mailing address:** 601 ZENA RUCKER RD, STE 105, SOUTHLAKE, TX 76092-6386
- **Mailing address phone:** (817) 466-2837
- **Mailing address fax:** (817) 488-6335

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | L9802 | TX | Yes |

## Other

- **Enumeration date:** 11/06/2014
- **Last updated:** 11/06/2014