Provider Demographics
NPI:1801304423
Name:SMITH, PATRICIA ELIZABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 W BUTTERNUT RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-9714
Mailing Address - Country:US
Mailing Address - Phone:765-618-7773
Mailing Address - Fax:
Practice Address - Street 1:1229 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1693
Practice Address - Country:US
Practice Address - Phone:844-695-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28167123A363LF0000X
IN71007739A363LF0000X, 363LP0808X
VA0024186662363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily