Provider Demographics
NPI:1316731649
Name:SMITH, LAURA YVONNE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:YVONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NE HIGHWAY 101 STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-4464
Mailing Address - Country:US
Mailing Address - Phone:541-921-3584
Mailing Address - Fax:541-614-1291
Practice Address - Street 1:2705 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1763
Practice Address - Country:US
Practice Address - Phone:541-921-3584
Practice Address - Fax:541-614-1291
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200641802RN163WP0808X
OR10043665363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health