Healthcare Provider Details

I. General information

NPI: 1780131318
Provider Name (Legal Business Name): LAURA LYNN SMITH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S MAIN
LAS CRUCES NM
88001-5034
US

IV. Provider business mailing address

9855 E. SOUTHERN AVE UNIT 50820
MESA AZ
85208-5034
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-8484
  • Fax: 575-449-2445
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR43507
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR43507
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: