MEDICARE: CHRISTA MARIE SMITH

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	31421	SC

General Provider Information

NPI Number	:	1952250664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA MARIE SMITH

Provider Business Mailing Address
First Line	:	216 LAKE FRANCES DR
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-3859
Country	:	US
Telephone Number	:	507-313-1516
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 LAKE FRANCES DR
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29170-3859
Country	:	US
Telephone Number	:	507-313-1516
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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