Individual
MARY JANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
2360 STONY BROOK DR, LOUISVILLE, KY 40220-4018
(502) 446-5462
(502) 394-3670
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3003746
KY
363L00000X
Nurse Practitioner
3746P
KY
363LF0000X
Family Nurse Practitioner
3003746
KY
Other
Enumeration date
07/28/2006
Last updated
03/11/2020
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