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General NPI Number Information
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NPI Number | 1790342830
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Entity Type | Individual
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Provider Name | CLYDE R SMITH BS, MSN, RN, PMHNP
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Gender | Male
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 2600 E BIDWELL ST STE 220
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City | FOLSOM
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State | CA
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Zip | 95630-6452
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Country | US
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Telephone | 747-200-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 E BIDWELL ST STE 220
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City | FOLSOM
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State | CA
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Zip | 95630-6452
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Country | US
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Telephone | 747-200-0022
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95033072
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95183506
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License Number State | CA
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