Healthcare Provider Details

I. General information

NPI: 1043120983
Provider Name (Legal Business Name): JEFFREY BRIAN SMITH APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 DUTCHMANS LN STE 5D
LOUISVILLE KY
40207-4744
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-6782
  • Fax: 502-540-7267
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4060142
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: