Individual
ANN LOUISE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, CPNP
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-4054
(682) 885-1033
Mailing address
PO BOX 99213, FORT WORTH, TX 76199-0213
(682) 885-4446
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
579494
TX
363LP0200X
Pediatric Nurse Practitioner
Primary
579494
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220124601
—
TX
01
—
220124602
CSHCN
TX
Enumeration date
04/10/2006
Last updated
07/24/2012
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