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General NPI Number Information
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NPI Number | 1841880275
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Entity Type | Individual
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Provider Name | HEATHER NICOLE SMITH
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Gender | Female
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 805 N WHITTINGTON PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40222-7101
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Country | US
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Telephone | 502-627-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 2645 E BANET RD
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City | SALEM
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State | IN
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Zip | 47167-7800
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Country | US
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Telephone | 812-844-1264
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 27067006A
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License Number State | IN
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