Individual provider Active NPI

Tanya Elaine Smith, AGANCP-BC

  • Acute Care Nurse Practitioner
  • Kingman, AZ
National Provider Identifier
1629583752
Registry record updated Dec 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP10770 Issued in AZ
Practice address
3269 N Stockton Hill Rd
Kingman, AZ 86409-3619
Phone
(928) 757-2102
NPI assigned
Dec 12, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X AP10770 AZ Primary

Addresses

Primary practice location

3269 N Stockton Hill Rd
Kingman, AZ 86409-3619

Mailing address

3269 N Stockton Hill Rd
Kingman, AZ 86409-3619
Phone (928) 757-2101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20180213000445 AZ Practitioner - Nurse Practitioner 4789944752 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kingman Healthcare IncGroup PAC ID 6901791367, 185 clinicians

Practice addresses (Care Compare)

1739 E Beverly Ave
Suite 209
Kingman, AZ 86409-3593
Phone (928) 627-8520

Hospital & facility affiliations

  • Kingman Regional Medical Center Hospital, Kingman, AZ, CCN 030055

Merit-based Incentive Payment System (MIPS)

Final score
84.85 of 100Reported as group
Quality
84.49
Promoting interoperability
83
Improvement activities
40
Cost
79.17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP10770AZMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kingman Healthcare, Inc Current Accepting new patients
Kingman Healthcare, Inc CurrentSince Aug 1, 2025 Accepting new patients
Kingman Healthcare, Inc CurrentSince Aug 1, 2025 Accepting new patients

Locations

2202 N Stockton Hill Rd
Ste 200
Kingman, AZ 86401
Phone (928) 692-4680

812 Airway Ave
Kingman, AZ 86409
Phone (928) 681-8710

1739 E Beverly Ave
Ste 209
Kingman, AZ 86409
Phone (928) 627-8520

3269 N Stockton Hill Rd
Kingman, AZ 86409
Phone (928) 757-0626

2202 N Stockton Hill Rd
Ste 100
Kingman, AZ 86401
Phone (928) 681-8706

Interoperability endpoints

  • Direct secure messaging: smith.tanya.elaine@direct.azkrmc.md

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1513036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513036800000",
    "number": "1629583752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3269 N STOCKTON HILL RD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093619",
            "telephone_number": "928-757-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3269 N STOCKTON HILL RD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093619",
            "telephone_number": "928-757-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TANYA",
        "middle_name": "ELAINE",
        "credential": "AGANCP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-12",
        "last_updated": "2017-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AZ",
            "license": "AP10770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingman, AZ

Sources for this page

Verify at the official NPI Registry.