Healthcare Provider Details

I. General information

NPI: 1952959751
Provider Name (Legal Business Name): NICOLE MARY SMITH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE BISHWATY CNP

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 PARK EAST DR STE 450
BEACHWOOD OH
44122-4318
US

IV. Provider business mailing address

1775 W LEXINGTON STE 150
CINCINNATI OH
45212-3668
US

V. Phone/Fax

Practice location:
  • Phone: 866-849-0692
  • Fax:
Mailing address:
  • Phone: 513-246-8000
  • Fax: 513-853-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1233738
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0028455
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-5919-0
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.451001
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026029678
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-85952-072
License Number StateKS
# 7
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP.0028455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: