Individual ProviderCarmen SmithNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709(703) 295-9360PECOS EnrollmentBased on the most recent information from CMS, provider Carmen Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:15 AM.Profile DetailsProvider ID1083780118Provider TypeIndividualFull NameSmith, CarmenTitleMs.CredentialCRNAGenderFemaleSole ProprietorNoEnumeration Date11/28/2006Last Updated3/20/2015Contact InformationPractice LocationPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709Phone(703) 295-9360Fax(703) 295-9369Mailing LocationMailing Address3998 Fair Ridge Drive, Suite 300, Fairfax, VA 22033-2921Phone(703) 295-9360Fax(703) 766-9725Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense0024165880VirginiaProvider IdentifiersIDDescriptionIssuerID484645DescriptionOtherIssuerNCPPOVirginiaID1083780118DescriptionMedicaidIssuerUnlistedVirginiaID139180DescriptionOtherIssuerTRIGONVirginiaIDK142-0002DescriptionOtherIssuerCARE FIRST 2005VirginiaIDP00265736DescriptionOtherIssuerMEDICARE RAILROADVirginia