MEDICARE: ANTOINE SMYRE PRS

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	175T00000X	Peer Specialist	0735001300	VA

General Provider Information

NPI Number	:	1073407441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINE SMYRE PRS

Provider Business Mailing Address
First Line	:	3819 HARROW DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-7146
Country	:	US
Telephone Number	:	804-940-9445
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 N ADAMS ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-3903
Country	:	US
Telephone Number	:	804-940-9445
Fax Number	:

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

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	07/09/2025

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Directions to “ ANTOINE SMYRE PRS” Practice Location

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