Amity Lynn Smith, PLLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

L9802 Issued in TX

Legal business name

AMITY LYNN SMITH, PLLC

Doing business as

Revolution Wellness and Prevention

Practice address

601 Zena Rucker Rd
Ste 105
Southlake, TX 76092-6386

Phone

(817) 466-2837

Fax

(817) 488-6335

NPI assigned

Nov 6, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amity Lynn Smith, MD

Title

Owner

Phone

(817) 488-2837

Specialties & licenses 1

Addresses

Other names 1

• Revolution Wellness and Prevention Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415232000000",
    "number": "1114323987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 ZENA RUCKER RD",
            "address_2": "STE 105",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926386",
            "telephone_number": "817-466-2837",
            "fax_number": "817-488-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 ZENA RUCKER RD",
            "address_2": "STE 105",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926386",
            "telephone_number": "817-466-2837",
            "fax_number": "817-488-6335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMITY LYNN SMITH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-06",
        "last_updated": "2014-11-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "AMITY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-488-2837",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "TX",
            "license": "L9802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revolution Wellness and Prevention",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Medical Specialty Clinic/Center in Southlake, TX
• Providers in Southlake, TX by specialty
• Medical Specialty Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.