Provider Demographics
NPI:1386892362
Name:SMELCER, TENNILLE ALYCEE (ACNP)
Entity type:Individual
Prefix:MRS
First Name:TENNILLE
Middle Name:ALYCEE
Last Name:SMELCER
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Gender:F
Credentials:ACNP
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Mailing Address - Street 1:2001 CRYSTAL SPRING AVE SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2462
Mailing Address - Country:US
Mailing Address - Phone:540-853-0100
Mailing Address - Fax:540-342-9308
Practice Address - Street 1:213 S JEFFERSON STREET
Practice Address - Street 2:SUITE 625
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-1700
Practice Address - Country:US
Practice Address - Phone:540-224-5688
Practice Address - Fax:540-224-5684
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2009-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024167947363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00659852Medicare PIN
VAMC11415Medicare PIN