Healthcare Provider Details

I. General information

NPI: 1730803792
Provider Name (Legal Business Name): SAMANTHA ASHLEY SMITH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA ASHLEY HOPKINS RN, BSN

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 S GEORGE ST # A
CHARLES TOWN WV
25414-4384
US

IV. Provider business mailing address

909 RIDGEBROOK RD STE 300
SPARKS GLENCOE MD
21152-9477
US

V. Phone/Fax

Practice location:
  • Phone: 443-383-9300
  • Fax: 855-866-8710
Mailing address:
  • Phone: 443-383-9300
  • Fax: 855-866-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number89411
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number114263
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: