Basic Information
| Provider Information | |||||||||
| NPI: | 1679053144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ASHANTI | ||||||||
| MiddleName: | NETANYA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | BS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 301 EVERETT ST UNIT A | ||||||||
| Address2: | |||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712703613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3377946090 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1325 WRIGHT AVE STE D | ||||||||
| Address2: | |||||||||
| City: | CROWLEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705262226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375145181 | ||||||||
| FaxNumber: | 3375145182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.