Provider Demographics
NPI:1407139546
Name:SMITH, STACY MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:M
Other - Last Name:ROBINETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1310 E 7TH ST STE J
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2518
Mailing Address - Country:US
Mailing Address - Phone:260-925-0305
Mailing Address - Fax:260-925-6041
Practice Address - Street 1:1310 E 7TH ST., STE J
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706
Practice Address - Country:US
Practice Address - Phone:260-925-0305
Practice Address - Fax:260-925-6041
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28131467A163W00000X
IN71003749A363LF0000X
IN351434141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily