Healthcare Provider Details

I. General information

NPI: 1578944575
Provider Name (Legal Business Name): REWA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

IV. Provider business mailing address

556 DOUGLAS AVE
LEXINGTON KY
40508-1072
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-4000
  • Fax:
Mailing address:
  • Phone: 859-913-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number2550
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: