Active NPI
Michael Alan Smith, RN
- School Registered Nurse
- Burkburnett, TX
National Provider Identifier
1235804212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Registered Nurse
- License
- 869768
- Practice address
- 100 N Avenue D
Burkburnett, TX 76354-3509 - Phone
- (940) 569-3381
- Fax
- (940) 569-2499
- NPI assigned
- Aug 12, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Low-Risk Neonatal Registered Nurse | 163WN0003X | 869768 | TX | |
| Pediatric Registered Nurse | 163WP0200X | 869768 | TX | |
| School Registered Nurse | 163WS0200X | 869768 | TX | Primary |
Addresses
Primary practice location
100 N Avenue D
Burkburnett, TX 76354-3509
Mailing address
901 Park Plaza Dr
Iowa Park, TX 76367-1136
Phone (817) 925-0251
Other practice location 1
1114 W Fm 1382
Cedar Hill, TX 75104-1204
Phone (682) 207-5061
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 869768 | Other | TX | TEXAS BOARD OF NURSING |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 869768 | TX | MD | Low-Risk Neonatal Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705536000000",
"number": "1235804212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 PARK PLAZA DR",
"city": "IOWA PARK",
"state": "TX",
"postal_code": "763671136",
"telephone_number": "817-925-0251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N AVENUE D",
"city": "BURKBURNETT",
"state": "TX",
"postal_code": "763543509",
"telephone_number": "940-569-3381",
"fax_number": "940-569-2499"
}
],
"practiceLocations": [
{
"address_1": "1114 W Fm 1382",
"address_purpose": "LOCATION",
"city": "Cedar Hill",
"state": "TX",
"postal_code": "751041204",
"country_code": "US",
"telephone_number": "682-207-5061",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SMITH",
"first_name": "MICHAEL",
"middle_name": "ALAN",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-12",
"last_updated": "2024-01-18",
"certification_date": "2024-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "163WN0003X",
"taxonomy_group": "",
"desc": "Registered Nurse, Neonatal, Low-Risk",
"state": "TX",
"license": "869768",
"primary": false
},
{
"code": "163WP0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Pediatrics",
"state": "TX",
"license": "869768",
"primary": false
},
{
"code": "163WS0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, School",
"state": "TX",
"license": "869768",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS BOARD OF NURSING",
"identifier": "869768",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burkburnett, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.