Nicole Lynn Smith, PSY.D., L.P.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

LP5504 Issued in MN

Practice address

10273 Yellow Circle Dr
Minnetonka, MN 55343-9144

Phone

(952) 215-3759

Fax

(952) 401-9805

NPI assigned

Dec 15, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, NY, WI3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  MN, NY, WI

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403740800000",
    "number": "1215206552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2841 BRYANT AVE S APT 130",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554084896",
            "telephone_number": "414-232-7277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10273 YELLOW CIRCLE DR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553439144",
            "telephone_number": "952-215-3759",
            "fax_number": "952-401-9805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "NICOLE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PSY.D., L.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-15",
        "last_updated": "2014-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP5504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James C Smith, RPT
• Kay Larae Smith, MT-BC
• Kristine L Smith, LMFT
• Kristine M Smith, FNP
• Mackenzie Smith
• Sara Ann Smith
• Sarah K.L. Smith, NP
• Sydney Smith
• Kishkalena Snider
• Casey J Snow

• Clinical Child & Adolescent Psychologist in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Clinical Child & Adolescent Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.