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General NPI Number Information
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NPI Number | 1487630091
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Entity Type | Individual
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Provider Name | MICHAEL SMITH RN
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Gender | Male
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 20 MEDICAL VILLAGE DR SUITE 258
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City | EDGEWOOD
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State | KY
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Zip | 41017
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Country | US
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Telephone | 859-301-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 5363 SHADOW HILL CT
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City | TAYLOR MILL
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State | KY
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Zip | 41015
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Country | US
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Telephone | 859-581-7952
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Fax | 859-581-7952
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1054975
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 037860
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License Number State | KY
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