Healthcare Provider Details

I. General information

NPI: 1417212952
Provider Name (Legal Business Name): STEPHANIE MARIE SMITH RN, MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 LIBERTY STREET
WEST MILFORD WV
26451
US

IV. Provider business mailing address

PO BOX 217
ROCK CAVE WV
26234-0217
US

V. Phone/Fax

Practice location:
  • Phone: 304-745-4568
  • Fax: 304-326-3700
Mailing address:
  • Phone: 304-924-6262
  • Fax: 304-924-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number73459
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: