Healthcare Provider Details

I. General information

NPI: 1225028897
Provider Name (Legal Business Name): GARY A SMITH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HWY 121 N. BYPASS SUITE I
MURRY KY
42071
US

IV. Provider business mailing address

PO BOX 636961
CINCINNATI OH
45263-6961
US

V. Phone/Fax

Practice location:
  • Phone: 270-226-1118
  • Fax: 270-226-1119
Mailing address:
  • Phone: 513-981-5130
  • Fax: 513-981-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3003886
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3003886
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: