Provider Demographics
NPI:1558046003
Name:SMITH, PAUL ALAN (RN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9154 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-7416
Mailing Address - Country:US
Mailing Address - Phone:304-733-9430
Mailing Address - Fax:304-733-9439
Practice Address - Street 1:9154 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:ONA
Practice Address - State:WV
Practice Address - Zip Code:25545-7416
Practice Address - Country:US
Practice Address - Phone:304-733-9430
Practice Address - Fax:304-733-9439
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV73114163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator