Active NPI
Sybille Goldback Smith, ARNP
- Family Nurse Practitioner
- Lakewood, WA
National Provider Identifier
1306864954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP30005537
- Practice address
- 11311 Bridgeport Way SW
Ste 100
Lakewood, WA 98499-3071 - Phone
- (253) 581-6688
- Fax
- (253) 512-2894
- NPI assigned
- Jul 18, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | AP30005537 | WA | |
| Family Nurse Practitioner | 363LF0000X | AP30005537 | WA | Primary |
Addresses
Primary practice location
11311 Bridgeport Way SW
Ste 100
Lakewood, WA 98499-3071
Mailing address
11311 Bridgeport Way SW
Ste 100
Lakewood, WA 98499-3071
Phone (253) 581-6688
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8929404 | Other | STATE CRIME VICTIMS | |
| P00306321 | Other | WA | RAILROAD |
| 9627324 | Medicaid | WA | |
| 0193324 | Other | STATE LICENSE |
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)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321574400000",
"number": "1306864954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11311 BRIDGEPORT WAY SW",
"address_2": "STE 100",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984993071",
"telephone_number": "253-581-6688",
"fax_number": "253-512-2894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11311 BRIDGEPORT WAY SW",
"address_2": "STE 100",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984993071",
"telephone_number": "253-581-6688",
"fax_number": "253-512-2894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "SYBILLE",
"middle_name": "GOLDBACK",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2011-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "AP30005537",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WA",
"license": "AP30005537",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE CRIME VICTIMS",
"identifier": "8929404",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "P00306321",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9627324",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "0193324",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.