Healthcare Provider Details

I. General information

NPI: 1497639371
Provider Name (Legal Business Name): GENIEVE SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 AIRPORT RD
CHAPMANVILLE WV
25508-9202
US

IV. Provider business mailing address

19 JIMS BRANCH RD
LAKE WV
25121-7106
US

V. Phone/Fax

Practice location:
  • Phone: 304-855-1200
  • Fax: 304-855-1230
Mailing address:
  • Phone: 304-601-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number123926
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: