Active NPI
Tonya Randolph Smith
- Child Mental Illness Respite Care
- Avondale, AZ
National Provider Identifier
1538590005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child Mental Illness Respite Care
- License
- 3467447
- Practice address
- 12227 W Hadley St
Avondale, AZ 85323-8434 - Phone
- (414) 617-8549
- NPI assigned
- Dec 9, 2013
- Last updated
- Dec 9, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child Mental Illness Respite Care | 385HR2055X | 3467447 | AZ | Primary |
Addresses
Primary practice location
12227 W Hadley St
Avondale, AZ 85323-8434
Mailing address
12227 W Hadley St
Avondale, AZ 85323-8434
Phone (414) 617-8549
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3467447 | AZ | MD | Child Mental Illness Respite Care |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386547200000",
"number": "1538590005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12227 W HADLEY ST",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853238434",
"telephone_number": "414-617-8549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12227 W HADLEY ST",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853238434",
"telephone_number": "414-617-8549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH SMITH",
"first_name": "TONYA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-09",
"last_updated": "2013-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "385HR2055X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Mental Illness, Child",
"state": "AZ",
"license": "3467447",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Avondale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.