Individual
MIRANDA P SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
2986 US HIGHWAY 431, BOAZ, AL 35957-5848
(256) 840-8181
(256) 344-9030
Mailing address
2986 US HIGHWAY 431, BOAZ, AL 35957-5848
(256) 840-8181
(256) 344-9030
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1117410
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-117410
AL LICENSE
AL
01
—
102I503103
MEDICARE PTAN
—
05
—
172427
—
AL
01
—
511-61302
BCBS
AL
Enumeration date
02/27/2013
Last updated
06/10/2015
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