Healthcare Provider Details

I. General information

NPI: 1821701541
Provider Name (Legal Business Name): SARAH A SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5693 YMCA PARK DR W
FORT WAYNE IN
46835-3280
US

IV. Provider business mailing address

8911 N CAPITAL OF TEXAS HWY
AUSTIN TX
78759-7247
US

V. Phone/Fax

Practice location:
  • Phone: 260-469-6603
  • Fax: 260-486-6123
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017426
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26983
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSMIT-C5WC1
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71018109A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: