Healthcare Provider Details

I. General information

NPI: 1033768163
Provider Name (Legal Business Name): MORGAN ELISABETH SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN ELISABETH LARIMORE

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8590 GEORGETOWN RD
INDIANAPOLIS IN
46268-1647
US

IV. Provider business mailing address

5744 ASHBY DR
INDIANAPOLIS IN
46221-4031
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-3115
  • Fax:
Mailing address:
  • Phone: 317-965-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28213421A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: