Healthcare Provider Details

I. General information

NPI: 1922356278
Provider Name (Legal Business Name): ALEXIS SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 JAY RD
BOULDER CO
80301-1605
US

IV. Provider business mailing address

2807 JAY RD
BOULDER CO
80301-1605
US

V. Phone/Fax

Practice location:
  • Phone: 303-506-4063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1001585-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70095118
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60254022
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70095118
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1001585-NP
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1696792
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: