Active NPI
Sara Rose Smith, LPN
- Licensed Practical Nurse
- Liberty, NY
National Provider Identifier
1255609293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 290440
- Practice address
- 5511 State Route 55
Liberty, NY 12754-2832 - Phone
- (865) 719-3060
- NPI assigned
- Dec 6, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 290440 | NY | Primary |
Addresses
Primary practice location
5511 State Route 55
Liberty, NY 12754-2832
Mailing address
PO Box 913
120 Main St Apt 2
Livingston Manor, NY 12758
Phone (865) 719-3060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 290440 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323129600000",
"number": "1255609293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 913",
"address_2": "120 MAIN ST APT 2",
"city": "LIVINGSTON MANOR",
"state": "NY",
"postal_code": "12758",
"telephone_number": "865-719-3060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5511 STATE ROUTE 55",
"city": "LIBERTY",
"state": "NY",
"postal_code": "127542832",
"telephone_number": "865-719-3060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "SARA",
"middle_name": "ROSE",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-06",
"last_updated": "2011-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "290440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Liberty, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.