Individual
MR. THOMAS J SMITH
Active
Individual
MR. THOMAS J SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ACNP
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
2019045891
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019045891
MISSOURI STATE BOARD OF NURSING NURSE PRACTITIONER LICENSE
MO
Enumeration date
07/28/2020
Last updated
07/28/2020
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