Individual provider Active NPI

Challis H. Smith, RN

  • Case Management Registered Nurse
  • Fort Eustis, VA
National Provider Identifier
1912059981
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management Registered NurseTaxonomy code 163WC0400X
License
0001072657 Issued in VA
Practice address
McDonald Army Health Center
576 Jefferson Ave
Fort Eustis, VA 23604-5548
Phone
(757) 314-7522
Fax
(757) 314-7520
NPI assigned
Jan 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Registered Nurse 163WC0400X 0001072657 VA Primary

Addresses

Primary practice location

McDonald Army Health Center
576 Jefferson Ave
Fort Eustis, VA 23604-5548

Mailing address

1836 Timberwood LN
Virginia Beach, VA 23454-2842
Phone (757) 961-6583

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
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
0001072657VAMDCase Management Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912059981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 TIMBERWOOD LN",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542842",
            "telephone_number": "757-961-6583",
            "fax_number": "757-961-6593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MCDONALD ARMY HEALTH CENTER",
            "address_2": "576 JEFFERSON AVE",
            "city": "FORT EUSTIS",
            "state": "VA",
            "postal_code": "236045548",
            "telephone_number": "757-314-7522",
            "fax_number": "757-314-7520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "CHALLIS",
        "middle_name": "H.",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "VA",
            "license": "0001072657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Eustis, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.