Provider Demographics
NPI:1609452234
Name:SMITH, YVONNE HARRIS (DNP, PMHNP-BC, RN-BC)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:HARRIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, RN-BC
Other - Prefix:DR
Other - First Name:YVONNE
Other - Middle Name:HARRIS
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, PMHNP-BC
Mailing Address - Street 1:106 CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-1440
Mailing Address - Country:US
Mailing Address - Phone:828-234-4729
Mailing Address - Fax:
Practice Address - Street 1:106 CYPRESS LN
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-1440
Practice Address - Country:US
Practice Address - Phone:828-234-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014378363LP0808X
NC2020131422363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5014378Medicaid