Individual
LISA R. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
(318) 629-4833
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
202048
LA
367A00000X
Advanced Practice Midwife
Primary
202048
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2503707
—
LA
Enumeration date
04/09/2019
Last updated
01/17/2024
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