MEDICARE: MATTHEW SMITH PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	25152	TN

General Provider Information

NPI Number	:	1568930410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW SMITH PMHNP-BC

Provider Business Mailing Address
First Line	:	4705 FRONTAGE RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2997
Country	:	US
Telephone Number	:	423-368-1251
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 S OCOEE ST
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-2601
Country	:	US
Telephone Number	:	423-479-5454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	11/08/2018

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Directions to “ MATTHEW SMITH PMHNP-BC” Practice Location

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