MEDICARE: TAMEKA SHANTE SMITH LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPN.152555.MEDS-IV	OH

General Provider Information

NPI Number	:	1063379659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMEKA SHANTE SMITH LPN

Provider Business Mailing Address
First Line	:	8444 N 90TH ST STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4437
Country	:	US
Telephone Number	:	602-248-8886
Fax Number	:	602-854-0504

Provider Business Practice Location Address
First Line	:	2632 WOODMAN CENTER CT
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45420-1477
Country	:	US
Telephone Number	:	937-739-7100
Fax Number	:	480-687-7361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	06/07/2026

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