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General NPI Number Information
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NPI Number | 1710720990
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Entity Type | Organization
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Legal Business Name | BRENT SMITH CRNP
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 150 MUNDY ST
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City | WILKES BARRE
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State | PA
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Zip | 18702-6830
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Country | US
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Telephone | 570-260-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 323 DANA ST
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City | WILKES BARRE
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State | PA
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Zip | 18702-5755
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Country | US
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Telephone | 570-260-6500
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BRENT SMITH
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Credential | NP
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Telephone | 570-260-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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