Individual
AVA GALE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N., P.M.H.N.P
Contact information
Practice address
3840 HULEN ST, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76107-7277
(817) 569-4396
(817) 569-4517
Mailing address
PO BOX 2603, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76113-2603
(817) 569-4396
(817) 569-4517
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
235655
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
235655
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088277101
—
TX
05
—
088277102
—
TX
05
—
088277103
—
TX
01
—
86N92S
BLUE CROSS BLUE SHIELD OF TEXAS
TX
Enumeration date
12/12/2006
Last updated
05/01/2013
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