Provider Demographics
NPI:1033864632
Name:SMITH, VANESSA ANNE (A-GNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:A-GNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:ANNE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:390 KEOWEE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6780
Practice Address - Country:US
Practice Address - Phone:864-885-7129
Practice Address - Fax:864-882-7240
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAG02220032363LG0600X
SC25960363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology