Michael T Smith Jr., LVN/LPN BSNC P-ANP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

L342112 Issued in TX

Practice address

13003 Shallow Falls LN
Pearland, TX 77584-6525

Phone

(832) 788-7624

NPI assigned

Apr 11, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 9

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elite Boutique Solutions

  • Health Maintenance Organization
  • Pearland, TX
  • NPI 1639812720

  Registered Nurse

  NPD Authorized official

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1457093304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7205 ALMEDA RD UNIT 300171",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772301059",
            "telephone_number": "832-788-7624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13003 SHALLOW FALLS LN",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775846525",
            "telephone_number": "832-788-7624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LVN/LPN BSNC P-ANP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "342112",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "22630966",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TX",
            "license": "342112",
            "primary": false
        },
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "TX",
            "license": "A030599",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "A35992",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "A35992",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "A030599",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "L342112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Logan Jonathan Smith, RBT
• Mackenzie Smith
• Melanie Smith, LPC
• Melody Brown Smith, MS CCC SLP
• Michael Richard Smith, D.D.S.
• Mikayla Smith, PHARMD
• Mya Smith
• Perry Lee Smith II, O.D.
• Rnae'Sha Frances Smith, CPHT
• Samone Smith, CNA

• Nurse Practitioner in Pearland, TX
• Providers in Pearland, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; 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.