Provider Demographics
NPI:1336156587
Name:SMITH, PATRICIA R (CRNP/PMH)
Entity Type:Individual
Prefix:PROF
First Name:PATRICIA
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNP/PMH
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:R
Other - Last Name:PILOTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5158 ORCHARD GRN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1930
Mailing Address - Country:US
Mailing Address - Phone:410-825-2281
Mailing Address - Fax:410-825-0757
Practice Address - Street 1:1407 YORK RD
Practice Address - Street 2:SUITE 309
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6097
Practice Address - Country:US
Practice Address - Phone:410-825-2281
Practice Address - Fax:410-825-0757
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR39655363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD361LE325Medicaid
MDN57763OtherCDS
MD010736J69Medicaid
MD010736J69Medicaid
MDMS1277260OtherDEA