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NPI Code Detail

MEDICARE: NICOLE SMITH

MEDICARE: NICOLE SMITH
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
1390200000XStudent in an Organized Health Care Education/Training Program3878NV
22084P0800XPsychiatry Physician28939NV

General Provider Information

NPI Number : 1902555212
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE SMITH
Provider Business Mailing Address
First Line : 745 W MOANA LN STE 300
Second Line :
City : RENO
State : NV
Zip : 89509-4980
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 745 W MOANA LN STE 300
Second Line :
City : RENO
State : NV
Zip : 89509-4980
Country : US
Telephone Number : 559-682-8456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2022
Last Update Date : 05/28/2026

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Directions to “ NICOLE SMITH ” Practice Location

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