Healthcare Provider Details

I. General information

NPI: 1871774950
Provider Name (Legal Business Name): MELANIE J SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE J JENKINS

II. Dates (important events)

Enumeration Date: 11/17/2007
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 CONSTITUTION BLVD
BEAVER FALLS PA
15010-1294
US

IV. Provider business mailing address

716 PARK RD
AMBRIDGE PA
15003-2420
US

V. Phone/Fax

Practice location:
  • Phone: 724-770-7999
  • Fax: 724-843-1514
Mailing address:
  • Phone: 907-304-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019163
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26822
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number321791
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: