Provider Demographics
NPI:1033768163
Name:SMITH, MORGAN ELISABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:ELISABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:ELISABETH
Other - Last Name:LARIMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5744 ASHBY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-4031
Mailing Address - Country:US
Mailing Address - Phone:317-965-3713
Mailing Address - Fax:
Practice Address - Street 1:8590 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1647
Practice Address - Country:US
Practice Address - Phone:317-872-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28213421A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28213421AOtherRN LICENSE