Healthcare Provider Details

I. General information

NPI: 1871361477
Provider Name (Legal Business Name): BLAKE E SMART APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 10/08/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W CENTER RD
OMAHA NE
68106-2714
US

IV. Provider business mailing address

7100 W CENTER RD
OMAHA NE
68106-2714
US

V. Phone/Fax

Practice location:
  • Phone: 402-506-9000
  • Fax: 402-506-9093
Mailing address:
  • Phone: 402-506-9000
  • Fax: 402-506-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number117109
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0999678-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: