Healthcare Provider Details

I. General information

NPI: 1861935058
Provider Name (Legal Business Name): CORTNEY SMITH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORTNEY JOHNSON CRNP

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 HIGHLAND AVE
WASHINGTON PA
15301-4062
US

IV. Provider business mailing address

37 HIGHLAND AVE
WASHINGTON PA
15301-4062
US

V. Phone/Fax

Practice location:
  • Phone: 724-223-1067
  • Fax:
Mailing address:
  • Phone: 724-223-1067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number86299
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017388
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN86299-NP-C
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP022853
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: