Provider Demographics
NPI:1043925035
Name:SMITH, FULGENTIA (CRNP-PMH)
Entity Type:Individual
Prefix:MRS
First Name:FULGENTIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 LEDO CREEK TER
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-5106
Mailing Address - Country:US
Mailing Address - Phone:301-502-6460
Mailing Address - Fax:608-305-8787
Practice Address - Street 1:12800 LEDO CREEK TER
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-5106
Practice Address - Country:US
Practice Address - Phone:240-583-9349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220646363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health