Healthcare Provider Details

I. General information

NPI: 1164366381
Provider Name (Legal Business Name): KATELYN MARIE SMITH HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3843 MOLLER RD
INDIANAPOLIS IN
46254-2930
US

IV. Provider business mailing address

3843 MOLLER RD
INDIANAPOLIS IN
46254-2930
US

V. Phone/Fax

Practice location:
  • Phone: 317-291-3376
  • Fax: 317-291-3746
Mailing address:
  • Phone: 317-291-3376
  • Fax: 317-291-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number17001692A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: