Healthcare Provider Details

I. General information

NPI: 1144652967
Provider Name (Legal Business Name): MICHELLE LYNN SMITH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LYNN GATTO

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4439 STATE ROUTE 159 SUITE G10
CHILLICOTHEE OH
45601-8207
US

IV. Provider business mailing address

4439 STATE ROUTE 159 SUITE G10
CHILLICOTHEE OH
45601-8207
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4300
  • Fax: 740-779-4391
Mailing address:
  • Phone: 740-779-4300
  • Fax: 740-779-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.14709
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: