Provider Demographics
NPI:1477806792
Name:SMITH, TAMEKA KIM (CRNP)
Entity type:Individual
Prefix:MS
First Name:TAMEKA
Middle Name:KIM
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10314 MALCOLM CIR
Mailing Address - Street 2:APT. L
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3924
Mailing Address - Country:US
Mailing Address - Phone:410-961-3389
Mailing Address - Fax:
Practice Address - Street 1:3601 ODONNELL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5238
Practice Address - Country:US
Practice Address - Phone:410-864-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172136363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health