Basic Information
| Provider Information | |||||||||
| NPI: | 1700852050 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMART | ||||||||
| FirstName: | TAMMIE | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 S 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571050900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055045400 | ||||||||
| FaxNumber: | 6055045150 | ||||||||
| Practice Location | |||||||||
| Address1: | 1035 S HIGHLINE PL | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571101000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057828305 | ||||||||
| FaxNumber: | 6053361677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0413 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 46022474342 | 05 | NE | MEDICAID | 490R3SM | 01 | MN | BLUE CROSS | OTHER | 490R3SM | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 9247819 | 01 | SD | DAKOTACARE | OTHER | 36793 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 678061043068 | 01 | SD | PREFERRED ONE | OTHER | 6827562 | 05 | SD | MEDICAID | 92411422911 | 01 | MN | PRIMEWEST | OTHER | 0120187 | 01 | SD | MEDICA | OTHER | 2197690 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 57105AH05 | 01 | SD | WPS TRICARE | OTHER | 0536219 | 05 | IA | MEDICAID | 244453 | 01 | SD | MIDLANDS CHOICE | OTHER | 4995003 | 01 | SD | BLUE CROSS | OTHER | 756174100 | 05 | MN | MEDICAID | HP47843 | 01 | SD | HEALTHPARTNERS | OTHER |