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General NPI Number Information
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NPI Number | 1538985049
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Entity Type | Individual
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Provider Name | ANTHONY GERMAINE SMITH CHW II/ PRSS
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Gender | Male
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Dates
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Enumeration Date | 11/29/2024
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Last Update Date | 11/02/2025
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Provider Practice Location Address
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Address Line | 4948 MOUNTAIN VISTA ST UNIT 20543
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City | LAS VEGAS
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State | NV
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Zip | 89112-8104
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Country | US
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Telephone | 702-929-5711
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Fax |
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Provider Business Mailing Address
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Address Line | 4948 MOUNTAIN VISTA ST UNIT 20543
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City | LAS VEGAS
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State | NV
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Zip | 89112-8104
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Country | US
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Telephone | 702-929-5711
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | PRSS-5160
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | PRSS-SUP-5142
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | CHW2-5096
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License Number State | NV
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