John Albert Smith, AGCNS-BC, CMSRN-BC

Primary specialty

Medical-Surgical Clinical Nurse SpecialistTaxonomy code 364SM0705X

License

APRN11011913 Issued in FL

Practice address

4481 Sugar Maple Dr
Wpafb, OH 45433-5536

Phone

(937) 713-7526

NPI assigned

Apr 14, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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": "1649894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1326781774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2706 OAK TRCE",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454318572",
            "telephone_number": "850-376-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4481 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "454335536",
            "telephone_number": "937-713-7526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JOHN",
        "middle_name": "ALBERT",
        "name_prefix": "Mr.",
        "credential": "AGCNS-BC, CMSRN-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-14",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "FL",
            "license": "APRN11011913",
            "primary": false
        },
        {
            "code": "364SG0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "FL",
            "license": "APRN11011913",
            "primary": false
        },
        {
            "code": "364SM0705X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Medical-Surgical",
            "state": "FL",
            "license": "APRN11011913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tavis M. Shaw, D.O.
• Matthew Sheneman, DO
• Christine M Shrader, PT, DPT
• Jeremy David Simmons, MD
• Kaela Maki Skerl, LPCC
• Joshua Taylor Smith, DDS
• Ryan R Smithers, FNP
• Stacy A Solheim, D.O.
• Teresa Dawn Soulati, RPH, BS PHARM
• Joe David Sparks, DMD

• Medical-Surgical Clinical Nurse Specialist in Wpafb, OH
• Providers in Wpafb, OH by specialty
• Medical-Surgical Clinical Nurse Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; 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.