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General NPI Number Information
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NPI Number | 1134202708
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Entity Type | Individual
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Provider Name | MYRTLE A SMITH CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3200 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304
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Country | US
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Telephone | 304-388-4077
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Fax | 304-388-9852
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Provider Business Mailing Address
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Address Line | 618 EVEREST CIRCLE
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City | ST ALBANS
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State | WV
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Zip | 29177
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Country | US
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Telephone | 304-722-3559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 21661
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 29741
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License Number State | WV
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