Provider Demographics
NPI:1750255972
Name:SMITHSON, NATHANIEL BEAU (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:BEAU
Last Name:SMITHSON
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 S SLATE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6481
Mailing Address - Country:US
Mailing Address - Phone:760-559-7038
Mailing Address - Fax:
Practice Address - Street 1:852 S SLATE CANYON DR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-6481
Practice Address - Country:US
Practice Address - Phone:760-559-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10921774-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health