Healthcare Provider Details

I. General information

NPI: 1275126617
Provider Name (Legal Business Name): TERESA ANN SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA ANN KING

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 SANDY LN
FAIRFIELD OH
45014-2738
US

IV. Provider business mailing address

4600 MONTGOMERY RD STE 400
CINCINNATI OH
45212-2600
US

V. Phone/Fax

Practice location:
  • Phone: 866-934-7450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR51285
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015595
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0029769
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number380425
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR51285
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: