Individual
MRS. MARY ANGELA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, FNP-C
Contact information
Practice address
496 SOUTHLAND DR, LEXINGTON, KY 40503-1827
(592) 888-2392
Mailing address
496 SOUTHLAND DR, LEXINGTON, KY 40503-1827
(859) 288-2425
(598) 288-7510
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3006095
KY
363LF0000X
Family Nurse Practitioner
6095P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001141526
BCBS
—
05
—
7100090450
—
KY
01
—
K029286
MEDICARE
—
01
—
P02044361
RR MEDICARE
—
Enumeration date
08/04/2009
Last updated
05/08/2023
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