Healthcare Provider Details

I. General information

NPI: 1053203778
Provider Name (Legal Business Name): MISTY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8413 RED SULPHUR PARKWAY
BALLARD WV
24981
US

IV. Provider business mailing address

307 MAPLE ST
HINTON WV
25951-2629
US

V. Phone/Fax

Practice location:
  • Phone: 304-716-5385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: