Healthcare Provider Details

I. General information

NPI: 1659871309
Provider Name (Legal Business Name): GLENNA NOELLE ARMISTEAD SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date: 02/20/2018
Reactivation Date: 02/27/2018

III. Provider practice location address

10469 ATLEE STATION RD STE 100
ASHLAND VA
23005-8913
US

IV. Provider business mailing address

10469 ATLEE STATION RD STE 100
ASHLAND VA
23005-8913
US

V. Phone/Fax

Practice location:
  • Phone: 804-944-2605
  • Fax:
Mailing address:
  • Phone: 804-923-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175870
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0024175870
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: