Provider Demographics
NPI:1619574639
Name:SMITH, AUSTIN BROOKS (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:BROOKS
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18660 BAGLEY RD BLDG 1404
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3483
Mailing Address - Country:US
Mailing Address - Phone:440-234-8746
Mailing Address - Fax:
Practice Address - Street 1:18660 BAGLEY RD BLDG 1404
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-234-8746
Practice Address - Fax:440-234-8748
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031505363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health