Individual
CHESTER CORY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, NP-C
Contact information
Practice address
1509 DULLES DR, LAFAYETTE, LA 70506-3718
(337) 408-0815
(337) 991-9288
Mailing address
1340 BROAD AVE, STE 300A, GULFPORT, MS 39501-2404
(228) 575-2700
(228) 575-2710
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
901546
MS
Other
Enumeration date
06/14/2016
Last updated
05/06/2019
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