Healthcare Provider Details

I. General information

NPI: 1477609600
Provider Name (Legal Business Name): ANTHONY GRIFFITH SMITH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NEWCOMB AVE SUITE 2C & D
MOUNT VERNON KY
40456-2725
US

IV. Provider business mailing address

140 NEWCOMB AVE SUITE 2C & D
MOUNT VERNON KY
40456-2725
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-4148
  • Fax: 606-256-7785
Mailing address:
  • Phone: 606-256-4148
  • Fax: 606-256-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1934882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: