Provider Demographics
NPI:1467022335
Name:SMITH, ROBERT MILES II (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MILES
Last Name:SMITH
Suffix:II
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:MILES
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1065 NE 125TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5833
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:6915 TUTT BLVD.
Practice Address - Street 2:SUITE #110B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3591
Practice Address - Country:US
Practice Address - Phone:719-445-1292
Practice Address - Fax:719-591-6486
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1652682163WP0808X
COAPN.0997084-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health