Healthcare Provider Details

I. General information

NPI: 1912771056
Provider Name (Legal Business Name): NATAUSHA NACOLE SMITH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 STATE ROUTE VV
KENNETT MO
63857-3822
US

IV. Provider business mailing address

935 STATE ROUTE VV
KENNETT MO
63857-3822
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-5925
  • Fax:
Mailing address:
  • Phone: 573-888-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023043696
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: