Healthcare Provider Details

I. General information

NPI: 1851539910
Provider Name (Legal Business Name): MICHELLE SMITH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 BLACKJACK RD
MOUNT VERNON OH
43050-9193
US

IV. Provider business mailing address

65 MESSIMER DR
NEWARK OH
43055-1874
US

V. Phone/Fax

Practice location:
  • Phone: 740-522-8477
  • Fax: 740-397-1582
Mailing address:
  • Phone: 740-522-8477
  • Fax: 740-788-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0041296
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: