Individual
NYTISHA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 N MAIN AVE, LOVINGTON, NM 88260-2813
(575) 386-6611
(575) 396-4465
Mailing address
1302 VIRGINIA AVE, LAKEWOOD, OH 44107-2433
(662) 418-1620
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
444511
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
0028910
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
79660
NM
Other
Enumeration date
12/04/2020
Last updated
03/27/2025
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