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General NPI Number Information
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NPI Number | 1336165232
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Entity Type | Individual
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Provider Name | LYNETTE S SMITH PHD, PMHNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 2642 CHANDLER DR APT 1814
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City | BOWLING GREEN
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State | KY
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Zip | 42104-6257
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Country | US
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Telephone | 812-021-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 2642 CHANDLER DR APT 1814
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City | BOWLING GREEN
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State | KY
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Zip | 42104-6257
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Country | US
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Telephone | 812-201-0222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3007259
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3007259
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License Number State | KY
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