Healthcare Provider Details

I. General information

NPI: 1770436958
Provider Name (Legal Business Name): ERICA D SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18805 W CATAWBA AVE STE 205A
CORNELIUS NC
28031-4609
US

IV. Provider business mailing address

102 CRAWFORD RD
GASTONIA NC
28056-0700
US

V. Phone/Fax

Practice location:
  • Phone: 704-612-0011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5024940
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: