Individual
MRS. MISTY D SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
620 MANASSAS CIR, BOSSIER CITY, LA 71112-4842
(318) 458-9088
Mailing address
620 MANASSAS CIR, BOSSIER CITY, LA 71112-4842
(318) 458-9088
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
794816
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP06370
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
794816
LIC #
LA
Enumeration date
05/05/2011
Last updated
07/29/2022
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