Provider Demographics
NPI:1821805011
Name:SMITH, ALLISON N (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15619 FIVE BRIDGES AVE
Mailing Address - Street 2:
Mailing Address - City:COLE CAMP
Mailing Address - State:MO
Mailing Address - Zip Code:65325-2289
Mailing Address - Country:US
Mailing Address - Phone:618-795-8087
Mailing Address - Fax:
Practice Address - Street 1:16216 BAXTER RD STES 205 AND 225
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4770
Practice Address - Country:US
Practice Address - Phone:636-532-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024042847363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health