Healthcare Provider Details

I. General information

NPI: 1558277632
Provider Name (Legal Business Name): SMITH MENTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DIXIE DR STE 108
KETTERING OH
45409-1532
US

IV. Provider business mailing address

2555 S DIXIE DR STE 108
KETTERING OH
45409-1532
US

V. Phone/Fax

Practice location:
  • Phone: 937-206-2472
  • Fax:
Mailing address:
  • Phone: 937-206-2472
  • Fax:

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: JESSICA SMITH
Title or Position: PMHNP
Credential: PMHNP-BC
Phone: 937-206-2472