Individual
MRS. JENNIFER RENEE BAGWELL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
416 S HENDERSON ST, FORT WORTH, TX 76104-1017
(682) 478-8123
(888) 851-5356
Mailing address
301 HILLCREST ST, MIDLOTHIAN, TX 76065-3608
(817) 371-6241
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
692657
TX
367500000X
Certified Registered Nurse Anesthetist
083700
TX
367500000X
Certified Registered Nurse Anesthetist
692657
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP118728
TX
Other
Enumeration date
12/28/2009
Last updated
06/20/2022
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