Healthcare Provider Details

I. General information

NPI: 1245767649
Provider Name (Legal Business Name): ASHLEY DAWN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 WILSON AVE
VERSAILLES KY
40383-1947
US

IV. Provider business mailing address

108 REDWOOD LN APT 6
MOREHEAD KY
40351-7118
US

V. Phone/Fax

Practice location:
  • Phone: 859-879-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT11636
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: