MEDICARE: DR. ANGELA M. SMITH DNP, PMHNP-BC, CMGT

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	163WD0400X	Diabetes Educator Registered Nurse	RN236161	OH

General Provider Information

NPI Number	:	1114174737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA M. SMITH DNP, PMHNP-BC, CMGT

Provider Business Mailing Address
First Line	:	20304 W WHITE TANKS MTN RD STE A
Second Line	:
City	:	WADDELL
State	:	AZ
Zip	:	85355-9895
Country	:	US
Telephone Number	:	419-566-3319
Fax Number	:

Provider Business Practice Location Address
First Line	:	9250 W THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3382
Country	:	US
Telephone Number	:	602-815-5964
Fax Number	:

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

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	03/12/2024

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