Provider Demographics
NPI:1255665048
Name:SMITH, ALISON K (NP)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:E
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0510
Practice Address - Country:US
Practice Address - Phone:804-327-8806
Practice Address - Fax:804-327-3065
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06563OtherMEDICARE GROUP PTAN
VAC06287OtherMEDICARE GROUP PTAN
VAC05844OtherMEDICARE GROUP PTAN
VAC01120OtherMEDICARE GROUP PTAN
VAC06543OtherMEDICARE GROUP PTAN
VAC06287OtherMEDICARE GROUP PTAN
VAC05844OtherMEDICARE GROUP PTAN
VA021708V63Medicare PIN
VA021707V43Medicare PIN
VA021709V20Medicare PIN