Healthcare Provider Details

I. General information

NPI: 1245251974
Provider Name (Legal Business Name): CAROL GREEN SMITH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FORT THOMAS AVE
FORT THOMAS KY
41075-2305
US

IV. Provider business mailing address

9672 WYMART AVE
CINCINNATI OH
45231-2415
US

V. Phone/Fax

Practice location:
  • Phone: 859-572-6781
  • Fax: 859-572-6724
Mailing address:
  • Phone: 513-521-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1109295
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN172647
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number4867S
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberNS01372
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: