Healthcare Provider Details

I. General information

NPI: 1689939100
Provider Name (Legal Business Name): NIKKI RACQUEL SMITH DNP,FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 TWO NOTCH RD STE 2-349
COLUMBIA SC
29223-4395
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-602-4904
  • Fax:
Mailing address:
  • Phone: 803-791-2491
  • Fax: 803-794-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number25556
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number25556
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: