Healthcare Provider Details

I. General information

NPI: 1043966658
Provider Name (Legal Business Name): CLYETTE S SMITH-WILCHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NORTH VERMONT HOLLYWOOD
LOS ANGELES CA
90027-9002
US

IV. Provider business mailing address

2309 W AVENUE O
PALMDALE CA
93551-3348
US

V. Phone/Fax

Practice location:
  • Phone: 323-522-6857
  • Fax:
Mailing address:
  • Phone: 661-317-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020525
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: