Healthcare Provider Details

I. General information

NPI: 1083775464
Provider Name (Legal Business Name): MR. CHAD B NESMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 WILSON LN
OWENSBORO KY
42303-6480
US

IV. Provider business mailing address

3750 RALPH AVE APT 127
OWENSBORO KY
42303-2204
US

V. Phone/Fax

Practice location:
  • Phone: 615-917-4972
  • Fax:
Mailing address:
  • Phone: 615-917-4972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number283131
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17737
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19242
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1596
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: