Provider Demographics
NPI:1366988149
Name:SMITH, GWEN PATRICIA (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:PATRICIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 S ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-9447
Mailing Address - Country:US
Mailing Address - Phone:828-692-6178
Mailing Address - Fax:828-692-2365
Practice Address - Street 1:571 S ALLEN RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-9447
Practice Address - Country:US
Practice Address - Phone:828-692-6178
Practice Address - Fax:828-692-2365
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222356363LG0600X, 363LP2300X, 363LA2200X
NC5017945363LP2300X, 363LG0600X, 363L00000X
NC6017945363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health