Healthcare Provider Details

I. General information

NPI: 1629618996
Provider Name (Legal Business Name): CHERYL SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 06/29/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 OFFICE PARK DR
KETTERING OH
45439-2214
US

IV. Provider business mailing address

3440 OFFICE PARK DR
KETTERING OH
45439-2214
US

V. Phone/Fax

Practice location:
  • Phone: 937-586-7725
  • Fax:
Mailing address:
  • Phone: 937-586-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number991813
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.210744
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: