Provider Demographics
NPI:1457223430
Name:SMITH, ANDREA LYNN
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 N BROADWAY ST STE 130
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1762
Mailing Address - Country:US
Mailing Address - Phone:513-696-1280
Mailing Address - Fax:
Practice Address - Street 1:1470 N BROADWAY ST STE 130
Practice Address - Street 2:SUITE 130
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1762
Practice Address - Country:US
Practice Address - Phone:513-696-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0038868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily