Individual
DYLAN RANDOLPH SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
7825 MCFARLAND LN STE A, INDIANAPOLIS, IN 46237-3630
(317) 888-5500
(317) 887-4806
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
3013498
KY
363LF0000X
Family Nurse Practitioner
Primary
71013246A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100612860
—
KY
Enumeration date
07/15/2019
Last updated
09/14/2023
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