Provider Demographics
NPI:1952643603
Name:SMITH, HOLLY NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:NICHOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6866 W STONEGATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8050
Mailing Address - Country:US
Mailing Address - Phone:317-768-6000
Mailing Address - Fax:317-768-6015
Practice Address - Street 1:13590B N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1409
Practice Address - Country:US
Practice Address - Phone:317-676-7858
Practice Address - Fax:317-868-5784
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074722A207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201165510Medicaid
IN201165510Medicaid