Provider Demographics
NPI:1972687234
Name:SMITH, AYNSLEY D (CNP)
Entity Type:Individual
Prefix:
First Name:AYNSLEY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1126
Mailing Address - Country:US
Mailing Address - Phone:651-232-7000
Mailing Address - Fax:
Practice Address - Street 1:1575 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1126
Practice Address - Country:US
Practice Address - Phone:651-232-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 152832-9363LG0600X
MN2995363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNB699OtherCHAMPUS
MNHP59168OtherHEALTHPARTNERS
WI41275100Medicaid
MN722T4SMOtherBLUE CROSS BLUE SHIELD
MN182094OtherUCARE
MN1046125OtherPREFERRED ONE
MN597378OtherARAZ
MN01-06279OtherMEDICA PRIMARY
MN01-22834OtherMEDICA CHOICE
MT4307121Medicaid
MN607658100Medicaid
MNHP59168OtherHEALTHPARTNERS
WI41275100Medicaid