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Individual
JIMMY REECE SMITH
Active
Individual
JIMMY REECE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1099382
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4026120
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1099382
KY BOARD OF NURSING
KY
Enumeration date
07/04/2022
Last updated
12/04/2024
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