Provider Demographics
NPI:1225375850
Name:SMITH, MARJORIE FIELDS (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:FIELDS
Last Name:SMITH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9184 BRACEY MILL PL
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-5154
Mailing Address - Country:US
Mailing Address - Phone:804-837-5311
Mailing Address - Fax:804-368-0267
Practice Address - Street 1:3932 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4119
Practice Address - Country:US
Practice Address - Phone:804-837-5311
Practice Address - Fax:804-368-0267
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182011363LP0808X
VA0015000188364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty