Healthcare Provider Details

I. General information

NPI: 1467022335
Provider Name (Legal Business Name): ROBERT MILES SMITH II PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT MILES SMITH RN

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 TUTT BLVD. SUITE #110B
COLORADO SPRINGS CO
80923-3591
US

IV. Provider business mailing address

1065 NE 125TH STREET SUITE 300
NORTH MIAMI FL
33161-5833
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-1292
  • Fax: 719-591-6486
Mailing address:
  • Phone: 888-852-6672
  • Fax: 305-891-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1652682
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0997084-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: