Individual
CLYDE R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS, MSN, RN, PMHNP
Contact information
Practice address
2600 E BIDWELL ST STE 220, FOLSOM, CA 95630-6452
(747) 200-0022
Mailing address
2600 E BIDWELL ST STE 220, FOLSOM, CA 95630-6452
(747) 200-0022
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95183506
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95033072
CA
Other
Enumeration date
05/23/2019
Last updated
04/08/2025
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