Jonathan Smith
Individual provider Active NPI Licensed Practical Nurse · Groves, TX
NPI 1497484653 · NPPES record last updated Jun 6, 2022
Key facts
- NPI
- 1497484653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 333616 (TX)
- Practice address
- 4548 Clermont Ave
Groves, TX 77619-3014 - Phone
- (409) 626-1427
- NPI assigned
- Jun 5, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 333616 | TX | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 333616 | TX | Yes |
Addresses
Primary practice location
4548 Clermont Ave
Groves, TX 77619-3014
Mailing address
4548 Clermont Ave
Groves, TX 77619-3014
Other providers in Groves, TX
- Selman Group
- Selman Partners LLC
- Thomas William Selman Jr.
- William Chase Selman
- Charles Arthur Short
- Sarah Smith
- Alexis Speer
- Star Mental Health Services, P.C.
- Heather Stippel
- Don Terrell
All providers in Groves, TX · Licensed Practical Nurse in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.