1386892362 NPI number — MRS. TENNILLE ALYCEE SMELCER ACNP

Table of content: MRS. TENNILLE ALYCEE SMELCER ACNP (NPI 1386892362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386892362 NPI number — MRS. TENNILLE ALYCEE SMELCER ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMELCER
Provider First Name:
TENNILLE
Provider Middle Name:
ALYCEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386892362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 CRYSTAL SPRING AVE SW
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24014-2462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-853-0100
Provider Business Mailing Address Fax Number:
540-342-9308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 S JEFFERSON STREET
Provider Second Line Business Practice Location Address:
SUITE 625
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24011-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-224-5688
Provider Business Practice Location Address Fax Number:
540-224-5684
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  0024167947 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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