Individual
KOKEYSHA R SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
8200 WALNUT HILL LN, DALLAS, TX 75231-4402
(214) 345-6789
Mailing address
4721 AUBURN RIDGE DR, FORT WORTH, TX 76123-4042
(817) 614-1641
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1091098
TX
Other
Enumeration date
08/19/2022
Last updated
08/31/2022
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