MEDICARE: ALLISON 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	209034289	IL

General Provider Information

NPI Number	:	1770425571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON SMITH PMHNP-BC

Provider Business Mailing Address
First Line	:	75 EXECUTIVE DR STE 447
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8112
Country	:	US
Telephone Number	:	312-973-2554
Fax Number	:	734-203-7149

Provider Business Practice Location Address
First Line	:	75 EXECUTIVE DR STE 447
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8112
Country	:	US
Telephone Number	:	312-973-2554
Fax Number	:	734-203-7149

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ ALLISON SMITH PMHNP-BC” Practice Location

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