Organization
SMITH'S HOMETOWN FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWANA M.L. SMITH APRN (OWNER)
(606) 599-8905
Entity
Organization
Contact information
Practice address
359 OLD US HIGHWAY 421, MANCHESTER, KY 40962-7538
(606) 599-8905
(606) 599-0354
Mailing address
359 OLD US HIGHWAY 421, MANCHESTER, KY 40962-7538
(606) 599-8905
(606) 599-0354
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
3006073
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11996475
CAQH
KY
05
—
7100100870
—
KY
Enumeration date
09/04/2014
Last updated
09/04/2014
Update your record
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