Healthcare Provider Details

I. General information

NPI: 1952541203
Provider Name (Legal Business Name): AMANDA ELIZABETH SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 FOUNTAIN CT STE 120
LEXINGTON KY
40509-2695
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-629-7245
  • Fax: 859-629-7246
Mailing address:
  • Phone:
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45030
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45030
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: