Provider Demographics
NPI:1720415037
Name:SMITH, LUCY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:L
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:13700 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3222
Mailing Address - Country:US
Mailing Address - Phone:804-794-6400
Mailing Address - Fax:804-897-0910
Practice Address - Street 1:13700 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3222
Practice Address - Country:US
Practice Address - Phone:804-794-6400
Practice Address - Fax:804-897-0910
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09462OtherGROUP PTAN