Healthcare Provider Details

I. General information

NPI: 1417423989
Provider Name (Legal Business Name): MAGNOLIA PSYCHIATRIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 GUILFORD DR # 2071
FREDERICK MD
21704-5257
US

IV. Provider business mailing address

4400 NE 77TH AVE STE 275
VANCOUVER WA
98662-6857
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-8466
  • Fax: 660-951-7859
Mailing address:
  • Phone: 360-567-8466
  • Fax: 660-951-7859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. NADINE ANNICA SMITH
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: NP
Phone: 443-823-6626