Healthcare Provider Details

I. General information

NPI: 1730024712
Provider Name (Legal Business Name): VEVERLY ELAINE SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42436 W CHISHOLM DR
MARICOPA AZ
85138-1667
US

IV. Provider business mailing address

42436 W CHISHOLM DR
MARICOPA AZ
85138-1667
US

V. Phone/Fax

Practice location:
  • Phone: 309-648-1472
  • Fax: 309-648-1472
Mailing address:
  • Phone: 309-648-1472
  • Fax: 309-648-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number257248
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: