Provider Demographics
NPI:1528552361
Name:SMITH, HEIDI (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-1030
Mailing Address - Country:US
Mailing Address - Phone:812-352-4300
Mailing Address - Fax:
Practice Address - Street 1:301 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1030
Practice Address - Country:US
Practice Address - Phone:812-352-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008134A363LP0200X
IN28205040A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics