Healthcare Provider Details

I. General information

NPI: 1235008483
Provider Name (Legal Business Name): NICHOLAS SMART RN, BSN, MSN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOWMAN DR LOWR LEVEL3
VOORHEES NJ
08043-9612
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-355-7118
  • Fax: 856-325-5222
Mailing address:
  • Phone: 856-355-7118
  • Fax: 856-325-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15438600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: