Ava Gale Smith, R.N., P.M.H.N.P

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

235655 Issued in TX

Practice address

3840 Hulen St
HTN, Client Accounting
Fort Worth, TX 76107-7277

Phone

(817) 569-4396

Fax

(817) 569-4517

NPI assigned

Dec 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367366400000",
    "number": "1396806774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2603",
            "address_2": "HTN, CLIENT ACCOUNTING",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761132603",
            "telephone_number": "817-569-4396",
            "fax_number": "817-569-4517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 HULEN ST",
            "address_2": "HTN, CLIENT ACCOUNTING",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077277",
            "telephone_number": "817-569-4396",
            "fax_number": "817-569-4517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "AVA",
        "middle_name": "GALE",
        "credential": "R.N., P.M.H.N.P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2013-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "235655",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "235655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TEXAS",
            "identifier": "86N92S",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "088277101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "088277103",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "088277102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam B. Smith, D.O.
• Alexander Smith
• Andrew John Smith, OT
• Ann Louise Smith, PHD, CPNP
• Aquantina Smith, MED, LAT
• Bailey Smith, CPNP
• Bert Doulgas Smith, MPT
• Betty Smith
• Bradley Michael Smith, A.T.P.
• Britney Smith, NP

• Psychiatric/Mental Health Nurse Practitioner in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; 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.