Individual
MISS TAVIA NIKOL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
11133 DUNN RD, SAINT LOUIS, MO 63136-6163
(314) 653-5700
Mailing address
10511 ROSETON CT, SAINT LOUIS, MO 63114-1957
(314) 420-2768
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2015019119
MO
Other
Enumeration date
06/26/2016
Last updated
06/26/2016
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