Healthcare Provider Details

I. General information

NPI: 1902422033
Provider Name (Legal Business Name): AMANDA ELAINE SMITH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 TRACY MILES RD STE 200
FRANKLIN IN
46131-5547
US

IV. Provider business mailing address

PO BOX 800
FRANKLIN IN
46131-0800
US

V. Phone/Fax

Practice location:
  • Phone: 317-346-3100
  • Fax: 317-346-3660
Mailing address:
  • Phone: 317-736-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28230345A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: