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Individual

STACIA SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
714 GRAVOIS RD, FENTON, MO 63026-7723
(636) 326-6100
Mailing address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2018022878
MO

Other

Enumeration date
08/08/2018
Last updated
08/08/2018
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