Provider Demographics
NPI:1689969297
Name:MITCHELL-SMITH, SERESEA RESHEA (FNP, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SERESEA
Middle Name:RESHEA
Last Name:MITCHELL-SMITH
Suffix:
Gender:F
Credentials:FNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 ALLENA LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 CLEAR CREEK RD STE 205
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5404
Practice Address - Country:US
Practice Address - Phone:254-781-6772
Practice Address - Fax:833-991-3992
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716082363LF0000X, 363L00000X
TXAP120401363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner