Healthcare Provider Details

I. General information

NPI: 1770395212
Provider Name (Legal Business Name): KEANNA SIMONE SMITH PMHNP-BC, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SLEATER KINNEY RD SE
LACEY WA
98503-2316
US

IV. Provider business mailing address

1210 SLEATER KINNEY RD SE
LACEY WA
98503-2316
US

V. Phone/Fax

Practice location:
  • Phone: 253-242-3560
  • Fax:
Mailing address:
  • Phone: 253-242-3560
  • Fax: 253-251-7435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70017820-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: