Healthcare Provider Details

I. General information

NPI: 1316426448
Provider Name (Legal Business Name): WESLEY ONEAL SMITH AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 HENRY TECKLENBURG DR STE 220
CHARLESTON SC
29414-5894
US

IV. Provider business mailing address

PO BOX 632709
CINCINNATI OH
45263-2709
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-8823
  • Fax: 843-606-8059
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number22422
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: