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General NPI Number Information
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NPI Number | 1609334630
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Entity Type | Individual
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Provider Name | MALLORY LYNNE SMITH AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 3900 KRESGE WAY STE 42
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City | LOUISVILLE
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State | KY
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Zip | 40207-4681
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Country | US
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Telephone | 502-899-3858
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Fax | 502-899-3878
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Provider Business Mailing Address
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Address Line | 1901 CAMPUS PL
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City | LOUISVILLE
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State | KY
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Zip | 40299-2308
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Country | US
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Telephone | 502-253-4924
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Fax | 502-489-5750
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4018626
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP140939
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 95014580
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License Number State | CA
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