Mariam Sophia Bouanane-Smith, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0024187257 Issued in VA

Practice address

580 Lynnhaven Pkwy Ste 203
Virginia Beach, VA 23452-7333

Phone

(757) 720-1040

Fax

(757) 720-1041

NPI assigned

Jan 4, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindful Oasis LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Virginia Beach, VA
  • NPI 1366260150

  Psychiatric/Mental Health

  Medicare reassignment NPD Authorized official
• Virginia Pac Services PC

  • Hospitalist Physician
  • Abingdon, VA
  • NPI 1073042800
  Medicare reassignment NPD
• CS Pacs 3 Southeast, LLC

  • Hospitalist Physician
  • Bluefield, WV
  • NPI 1154104958

  VA

  Medicare reassignment NPD
• NV Pacs 2 LLC

  • Hospitalist Physician
  • Las Vegas, NV
  • NPI 1427534809

  VA

  Medicare reassignment NPD
• Center for Seeking Peace, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Hampton, VA
  • NPI 1376141234
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787097600000",
    "number": "1053024026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 LYNNHAVEN PKWY STE 203",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527333",
            "telephone_number": "757-720-1040",
            "fax_number": "757-720-1041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 LYNNHAVEN PKWY STE 203",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527333",
            "telephone_number": "757-720-1040",
            "fax_number": "757-720-1041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUANANE-SMITH",
        "first_name": "MARIAM",
        "middle_name": "SOPHIA",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-04",
        "last_updated": "2026-08-19",
        "certification_date": "2026-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024187257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serita Bostick, LMT
• Jaclyn Boswood
• Tara Boszczuk, MS, CF-SLP
• John Karl Botin
• Sanae Bouallali, D.D.S.
• Danielle Bouldin, PHARMD
• Boulevard Medical Center Inc.
• Jennifer Boulware, SLPA
• Boundless Inc
• Kevin B Bounds, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.