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General NPI Number Information
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NPI Number | 1558576454
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Entity Type | Individual
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Provider Name | STACI CHARLENE SMITH DO
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 911 BYPASS RD BLDG A
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City | PIKEVILLE
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State | KY
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Zip | 41501-1602
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Country | US
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Telephone | 606-430-3500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 432
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City | PIKEVILLE
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State | KY
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Zip | 41502-0432
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Country | US
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Telephone |
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 2458
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 04204
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2458
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 34.010025
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License Number State | OH
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