1730803792 NPI number — SAMANTHA ASHLEY SMITH PMHNP-BC

Table of content: SAMANTHA ASHLEY SMITH PMHNP-BC (NPI 1730803792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730803792 NPI number — SAMANTHA ASHLEY SMITH PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
SAMANTHA
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOPKINS
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
ASHLEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730803792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 RIDGEBROOK RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS GLENCOE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21152-9477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-383-9300
Provider Business Mailing Address Fax Number:
855-866-8710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1263 S GEORGE ST # A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLES TOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25414-4384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-383-9300
Provider Business Practice Location Address Fax Number:
855-866-8710
Provider Enumeration Date:
10/03/2022

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: 163WW0000X , with the licence number:  89411 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 114263 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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