Healthcare Provider Details

I. General information

NPI: 1447135355
Provider Name (Legal Business Name): EMILY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 116TH AVE NE STE 304
BELLEVUE WA
98004-3057
US

IV. Provider business mailing address

1600 116TH AVE NE STE 304
BELLEVUE WA
98004-3057
US

V. Phone/Fax

Practice location:
  • Phone: 425-598-2646
  • Fax: 901-287-4540
Mailing address:
  • Phone: 425-598-2646
  • Fax: 833-450-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP70092695
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: