Healthcare Provider Details

I. General information

NPI: 1154735173
Provider Name (Legal Business Name): CHRISTY WAGNER SMITH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY A WAGNER

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-262-6772
  • Fax: 614-533-0162
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA16610NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: