Individual
BONNIE KELLAM SMITH
Active
Individual
BONNIE KELLAM SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHCNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN112114
LA
163W00000X
Registered Nurse
RN452065
TX
363LW0102X
Women's Health Nurse Practitioner
AP04701
LA
363LW0102X
Women's Health Nurse Practitioner
Primary
AP103014
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0708125-03
—
TX
05
—
1815365
—
LA
Enumeration date
06/27/2007
Last updated
09/13/2019
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