Healthcare Provider Details

I. General information

NPI: 1942364666
Provider Name (Legal Business Name): SUSAN ELAINE NESMITH N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 N DIXIE AVE
ELIZABETHTOWN KY
42701-2503
US

IV. Provider business mailing address

1623 HUTCHERSON LN
ELIZABETHTOWN KY
42701-8977
US

V. Phone/Fax

Practice location:
  • Phone: 270-737-1212
  • Fax:
Mailing address:
  • Phone: 270-360-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number2852P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: