Latisha Nicole Smith

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61318754 Issued in WA

Practice address

Comnavsurfpac
2841 Rendova Road
San Diego, CA 92155-5490

Phone

(619) 556-8449

NPI assigned

Mar 25, 2020

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1194352591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2170 BIRCH RD APT 110",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919152034",
            "telephone_number": "301-300-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COMNAVSURFPAC",
            "address_2": "2841 RENDOVA ROAD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921555490",
            "telephone_number": "619-556-8449"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Walter Reed National Military Medical Center",
            "address_purpose": "LOCATION",
            "city": "Bethesda",
            "state": "MD",
            "postal_code": "208890001",
            "country_code": "US",
            "telephone_number": "301-300-1199",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Children's Hospital of Philadelphia",
            "address_2": "3401 Civic Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "301-300-1199",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Fort Belvoir Community Hospital",
            "address_2": "9300 DeWitt Loop",
            "address_purpose": "LOCATION",
            "city": "Fort Belvoir",
            "state": "VA",
            "postal_code": "22060",
            "country_code": "US",
            "telephone_number": "301-300-1199",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9040 Jackson Ave",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984310001",
            "country_code": "US",
            "telephone_number": "301-300-1199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LATISHA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-25",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61318754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI-CARE",
            "identifier": "1194352591",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "latisha.n.smith.mil@health.mil",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "COMNAVSURFPAC",
            "address_2": "2841 Rendova Road",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921555490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Krista Rae Smith, LPCC
• Kristen Diane Smith, M.D.
• Krystah Lynn Smith
• Kyra Smith
• Lacey Noel Smith
• Latoya A Smith, BCBA
• Lauren Smith
• Lauren G Smith, MS, OTR/L
• Linda B Smith, MD
• Linda J Smith, PA

• Psychiatric/Mental Health Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.