Provider Demographics
NPI:1417514639
Name:SMITH, SHYANN MONIQUE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:SHYANN
Middle Name:MONIQUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 RIDENOUR PKWY NW APT 1324
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4541
Mailing Address - Country:US
Mailing Address - Phone:404-725-0130
Mailing Address - Fax:
Practice Address - Street 1:300 CHASTAIN CENTER BLVD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5580
Practice Address - Country:US
Practice Address - Phone:770-218-1997
Practice Address - Fax:770-218-1975
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN225069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily