MEDICARE: TONYA KAY SMITH RN

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	163WG0000X	General Practice Registered Nurse	RN2000175167	MO

General Provider Information

NPI Number	:	1184248270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA KAY SMITH RN

Provider Business Mailing Address
First Line	:	4473 FOREST PARK AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7712 MEADOW VIEW CIR
Second Line	:
City	:	UNION
State	:	MO
Zip	:	63084-2430
Country	:	US
Telephone Number	:	314-791-3125
Fax Number	:

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

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	06/03/2020

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