Basic Information
| Provider Information | |||||||||
| NPI: | 1598250128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | STUART | ||||||||
| MiddleName: | LLOYD | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W EAGLE DR | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762343745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9406278982 | ||||||||
| FaxNumber: | 9406277464 | ||||||||
| Practice Location | |||||||||
| Address1: | 1820 ONEAL ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405803070 | ||||||||
| FaxNumber: | 9405802042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2018 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 832334 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 832334 | 01 | TX | LICENSE | OTHER |