Vernon Michael Smith, APN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209-000798 Issued in IL

Practice address

5500 S Damen Ave
Chicago, IL 60636-1107

Phone

(773) 776-8800

Fax

(773) 776-8801

NPI assigned

Jul 3, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

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": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215043200000",
    "number": "1952564551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 S DAMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606361107",
            "telephone_number": "773-776-8800",
            "fax_number": "773-776-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 S DAMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606361107",
            "telephone_number": "773-776-8800",
            "fax_number": "773-776-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "VERNON",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-03",
        "last_updated": "2008-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-000798",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IL",
            "license": "209-000798",
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "IL",
            "license": "209-000798",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209-000798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Smith, D.O.
• Tiy Smith, MD
• Tyler James Smith
• Valerie Smith, LCSW
• Vanessa L. Smith
• Victoria Smith
• Wayland Barber Smith, L.C.S.W./C.A.D.C.
• Zachary Tyler Smith
• Zhana Smith
• Katie Smithberg, MS, CCC-SLP

• Pediatric Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; 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.