Healthcare Provider Details

I. General information

NPI: 1639434327
Provider Name (Legal Business Name): HEATHER LYNN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER LYNN RAINS

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE
CINCINNATI OH
45219-4231
US

IV. Provider business mailing address

222 PIEDMONT AVE
CINCINNATI OH
45219-4231
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8690
  • Fax: 513-475-7593
Mailing address:
  • Phone: 513-475-8690
  • Fax: 513-475-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50003601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: