Individual
MR. THOMAS J SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
803 RENA ST, KIRKSVILLE, MO 63501-2012
(660) 342-5295
Mailing address
803 RENA ST, KIRKSVILLE, MO 63501-2012
(660) 342-5295
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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