Individual
JUSTIN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1301 1ST ST, KENNETT, MO 63857-2525
(573) 686-5550
Mailing address
209 S MAIN ST, POPLAR BLUFF, MO 63901-5831
(573) 686-5550
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2015023426
AR
367500000X
Certified Registered Nurse Anesthetist
R077620
AR
Other
Enumeration date
08/20/2015
Last updated
08/20/2015
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