Provider Demographics
NPI:1073874095
Name:SMITH, ERICA LYNN (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2401
Mailing Address - Country:US
Mailing Address - Phone:937-498-2311
Mailing Address - Fax:
Practice Address - Street 1:104 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:OH
Practice Address - Zip Code:45302-8553
Practice Address - Country:US
Practice Address - Phone:937-394-2900
Practice Address - Fax:937-498-5483
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13389-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily