Healthcare Provider Details

I. General information

NPI: 1356159321
Provider Name (Legal Business Name): TANNER BRADLEY SMITH MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 MARKET AVE N STE 100
CANTON OH
44721-2430
US

IV. Provider business mailing address

6545 MARKET AVE N STE 100
CANTON OH
44721-2430
US

V. Phone/Fax

Practice location:
  • Phone: 614-964-5084
  • Fax:
Mailing address:
  • Phone: 614-964-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042224
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: