MEDICARE: KATHLEEN SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	130775	KY

General Provider Information

NPI Number	:	1548273741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN SMITH

Provider Business Mailing Address
First Line	:	6000 BROWNSBORO PARK BLVD STE G
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-7201
Country	:	US
Telephone Number	:	502-681-3219
Fax Number	:	502-681-3219

Provider Business Practice Location Address
First Line	:	6000 BROWNSBORO PARK BLVD STE G
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-7201
Country	:	US
Telephone Number	:	502-681-3219
Fax Number	:	502-721-0333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	12/10/2024

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Directions to “ KATHLEEN SMITH ” Practice Location

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