Healthcare Provider Details

I. General information

NPI: 1477135218
Provider Name (Legal Business Name): KATIE SMART FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 INDUSTRIAL PKWY
BRUNSWICK ME
04011-7314
US

IV. Provider business mailing address

12 INDUSTRIAL PKWY
BRUNSWICK ME
04011-7314
US

V. Phone/Fax

Practice location:
  • Phone: 207-373-8530
  • Fax: 207-477-7195
Mailing address:
  • Phone: 207-373-8530
  • Fax: 207-477-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP211156
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: