Provider Demographics
NPI:1730665670
Name:SMITH, COLENE M (NP)
Entity type:Individual
Prefix:
First Name:COLENE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8239 MEADOWBRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2318
Mailing Address - Country:US
Mailing Address - Phone:804-730-8713
Mailing Address - Fax:804-730-0839
Practice Address - Street 1:8239 MEADOWBRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2318
Practice Address - Country:US
Practice Address - Phone:804-730-8713
Practice Address - Fax:804-730-0839
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176338363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024176338Medicaid