Healthcare Provider Details

I. General information

NPI: 1366028698
Provider Name (Legal Business Name): WHITNEY NICOLE SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY NICOLE HAMPTON

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8426
US

IV. Provider business mailing address

89 AVIAN LN
LONDON KY
40744-8960
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-1212
  • Fax:
Mailing address:
  • Phone: 606-309-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3015442
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: