Healthcare Provider Details

I. General information

NPI: 1376131227
Provider Name (Legal Business Name): ASHLEY SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 SPRING FOREST RD
RALEIGH NC
27615-7528
US

IV. Provider business mailing address

133 CEDAR KNOLL CIR
PINEVILLE NC
28134-6601
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 630-915-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209022453
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN305653
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5019996
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: