Provider Demographics
NPI:1053816611
Name:SMILEY, GINNY LEA (RNC)
Entity type:Individual
Prefix:
First Name:GINNY
Middle Name:LEA
Last Name:SMILEY
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 BARKSDALE BLVD LOT 109
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-8637
Mailing Address - Country:US
Mailing Address - Phone:318-347-1433
Mailing Address - Fax:
Practice Address - Street 1:6507 BARKSDALE BLVD LOT 109
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-8637
Practice Address - Country:US
Practice Address - Phone:318-347-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN133462163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive CareGroup - Single Specialty