Provider Demographics
NPI:1801825245
Name:SMITH, WILLIAM C III (APRN, BC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:SMITH
Suffix:III
Gender:M
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14361 CAMDEN LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5823
Mailing Address - Country:US
Mailing Address - Phone:317-430-7272
Mailing Address - Fax:
Practice Address - Street 1:9001 WESLEYAN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268
Practice Address - Country:US
Practice Address - Phone:317-947-5530
Practice Address - Fax:855-422-5182
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-06970-NP363LF0000X
IN71002449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200942240Medicaid
IN200942240Medicaid
IN259950EMedicare PIN