Healthcare Provider Details

I. General information

NPI: 1033864632
Provider Name (Legal Business Name): VANESSA ANNE SMITH A-GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA ANNE JONES

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 KEOWEE SCHOOL RD
SENECA SC
29672-6780
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-885-7129
  • Fax: 864-882-7240
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG02220032
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number25960
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: