Healthcare Provider Details

I. General information

NPI: 1962284240
Provider Name (Legal Business Name): TANYA SIMPKINS SMITH AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 ROBINSON RD
NEWTON NC
28658-9715
US

IV. Provider business mailing address

3975 ROBINSON RD
NEWTON NC
28658-9715
US

V. Phone/Fax

Practice location:
  • Phone: 828-466-0466
  • Fax: 828-466-8862
Mailing address:
  • Phone: 828-466-0466
  • Fax: 828-466-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5019290
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5019290
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5019290
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5019290
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: