Healthcare Provider Details

I. General information

NPI: 1174241848
Provider Name (Legal Business Name): CHIAMAKA SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 ANGIES WAY STE 420
LOUISVILLE KY
40241-2850
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-394-6200
  • Fax: 502-394-6210
Mailing address:
  • Phone: 502-559-9411
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3018179
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3018179
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: