Healthcare Provider Details

I. General information

NPI: 1023984739
Provider Name (Legal Business Name): TRACI LEE SMITH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 AIRPORT RD STE 200
EVERETT WA
98204-8711
US

IV. Provider business mailing address

1715 NEW HAVEN RD
JACKSONVILLE FL
32211-4794
US

V. Phone/Fax

Practice location:
  • Phone: 888-281-4325
  • Fax:
Mailing address:
  • Phone: 971-258-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11042893
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70083288
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: