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NPI Code Detail

MEDICARE: MECHELL SPADIE SMITH NP-C

MEDICARE: MECHELL SPADIE SMITH NP-C
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
1363LF0000XFamily Nurse Practitioner201808NC

General Provider Information

NPI Number : 1538272679
Entity Type Code : Individual
Provider Name (Legal Business Name) : MECHELL SPADIE SMITH NP-C
Provider Business Mailing Address
First Line : 135 E RICH BLVD
Second Line :
City : ELIZABETH CITY
State : NC
Zip : 27909-5518
Country : US
Telephone Number : 252-333-1277
Fax Number : 252-333-1877
Provider Business Practice Location Address
First Line : 135 E RICH BLVD
Second Line :
City : ELIZABETH CITY
State : NC
Zip : 27909-5518
Country : US
Telephone Number : 252-333-1277
Fax Number : 252-333-1877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 06/10/2013

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