Basic Information
Provider Information
NPI: 1043647696
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SMITH
FirstName: BRITTANY
MiddleName: BOHL
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3901A SPICEWOOD SPRINGS RD
Address2: STE 201
City: AUSTIN
State: TX
PostalCode: 787598723
CountryCode: US
TelephoneNumber: 7372266700
FaxNumber:  
Practice Location
Address1: 3901A SPICEWOOD SPRINGS RD
Address2: STE 201
City: AUSTIN
State: TX
PostalCode: 787598723
CountryCode: US
TelephoneNumber: 7372266700
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/27/2013
LastUpdateDate: 09/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X749764TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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