=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306361084
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY KAY SMITHSON APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2017
-----------------------------------------------------
Last Update Date | 08/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 E MARKET ST
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44304-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-905-6071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 STEEPLECHASE LN
-----------------------------------------------------
City | MUNROE FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44262-1747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-715-8115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | AG07170068
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------