Individual
BRENT TYLER SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
150 MUNDY ST, WILKES BARRE, PA 18702-6830
(570) 260-6500
Mailing address
150 MUNDY ST, WILKES BARRE, PA 18702-6830
(570) 260-6500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP022819
PA
363LF0000X
Family Nurse Practitioner
SP002819
PA
Other
Enumeration date
10/24/2019
Last updated
01/04/2026
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