Healthcare Provider Details

I. General information

NPI: 1811220171
Provider Name (Legal Business Name): SUZANN SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 01/21/2023
Certification Date: 01/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 MARIE LANGDON DR
MANCHESTER KY
40962-6329
US

IV. Provider business mailing address

11217 HIGHWAY 421 S
TYNER KY
40486-8352
US

V. Phone/Fax

Practice location:
  • Phone: 606-599-4080
  • Fax: 606-712-1200
Mailing address:
  • Phone: 606-598-5104
  • Fax: 606-712-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3006246
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006246
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: