Healthcare Provider Details

I. General information

NPI: 1710793245
Provider Name (Legal Business Name): SUSAN KAYE SMITLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S LANDMARK AVE
BLOOMINGTON IN
47403-5003
US

IV. Provider business mailing address

3957 WOODVIEW DR
COLUMBUS IN
47201-8036
US

V. Phone/Fax

Practice location:
  • Phone: 812-822-7021
  • Fax:
Mailing address:
  • Phone: 317-755-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016091A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: