Healthcare Provider Details

I. General information

NPI: 1831739663
Provider Name (Legal Business Name): NATASHA MARIE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 56TH ST SE
CHARLESTON WV
25304-2361
US

IV. Provider business mailing address

3 2ND ST
CROWN CITY OH
45623-7524
US

V. Phone/Fax

Practice location:
  • Phone: 304-322-3037
  • Fax:
Mailing address:
  • Phone: 740-441-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number125536
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: