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General NPI Number Information
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NPI Number | 1700889409
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Entity Type | Individual
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Provider Name | JUSTIN WARREN SMITH CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 200 ABRAHAM FLEXNER WAY
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City | LOUISVILLE
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State | KY
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Zip | 40202
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Country | US
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Telephone | 502-587-4404
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Fax | 502-587-4156
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Provider Business Mailing Address
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Address Line | 100 E LIBERTY ST STE 800
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City | LOUISVILLE
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State | KY
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Zip | 40202-1428
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Country | US
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Telephone | 502-540-3341
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Fax | 502-540-3393
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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 | 166747
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License Number State | TN
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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 | 71001350A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 041315277
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3004228
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License Number State | KY
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