Individual
MICHAEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
20 MEDICAL VILLAGE DR, SUITE 258, EDGEWOOD, KY 41017
(859) 301-2211
Mailing address
5363 SHADOW HILL CT, TAYLOR MILL, KY 41015
(859) 581-7952
(859) 581-7952
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1054975
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
037860
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000389807
ANTHEM
—
05
—
2166454
—
OH
05
—
74097817
—
KY
Enumeration date
12/16/2005
Last updated
04/20/2008
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