Healthcare Provider Details

I. General information

NPI: 1952515025
Provider Name (Legal Business Name): SUNSHINE M SMOOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PLUMMER STREET
CAMPTON KY
41300-7484
US

IV. Provider business mailing address

PO BOX 690
BEATTYVILLE KY
41311-0690
US

V. Phone/Fax

Practice location:
  • Phone: 606-668-7385
  • Fax: 606-668-7009
Mailing address:
  • Phone: 606-464-0151
  • Fax: 606-464-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42444
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: