Nicole Smith

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

923 Issued in WV

Practice address

RT. 10 Three Mile Curve
Logan, WV 25601-9998

Phone

(304) 792-7130

Fax

(304) 792-7146

NPI assigned

Jan 11, 2007

Last updated

Jul 1, 2010By the provider in NPPES

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 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Clinical Psychologist

Education

Other, 1996

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21756/brand/1/csg/1/fhir/r4

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

• Logan Mingo Area Mental Health

  • Health Service Clinic/Center
  • Logan, WV
  • NPI 1235408121
  NPD (past)

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277942400000",
    "number": "1316097538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 176",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256010176",
            "telephone_number": "304-792-7130",
            "fax_number": "304-792-7146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RT. 10 THREE MILE CURVE",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256019998",
            "telephone_number": "304-792-7130",
            "fax_number": "304-792-7146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2010-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WV",
            "license": "923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005460001",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005460002",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810011604",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005460000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabrina Sigmon
• Brian Allen Simpkins
• Amanda Sisler
• Christina Smith
• John Walton Smith, PRSS
• Sharla R Smith, PRSS
• Southern West Virginia Nephrology Associates
• Southwestern Regional Day Report Center
• Southwestern Regional Day Report Center
• Janet Sparks

• Clinical Psychologist in Logan, WV
• Providers in Logan, WV by specialty
• Clinical Psychologist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.