Provider Demographics
NPI:1619439908
Name:SMITH, ANGEL MICHELLE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:MICHELLE
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:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-0426
Mailing Address - Country:US
Mailing Address - Phone:276-963-0111
Mailing Address - Fax:276-963-0005
Practice Address - Street 1:1944 BROOKSIDE DR STE 3
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4618
Practice Address - Country:US
Practice Address - Phone:423-343-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179738363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health