Provider Demographics
NPI:1881209971
Name:SMARR, AMBER NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:SMARR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NICOLE
Other - Last Name:SMARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMBER RUSSELL RN
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:CANVAS
Mailing Address - State:WV
Mailing Address - Zip Code:26662-0392
Mailing Address - Country:US
Mailing Address - Phone:304-640-3305
Mailing Address - Fax:
Practice Address - Street 1:764 HARNESS ROAD
Practice Address - Street 2:
Practice Address - City:FENWICK
Practice Address - State:WV
Practice Address - Zip Code:26202
Practice Address - Country:US
Practice Address - Phone:304-640-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVF06202263363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty