Individual
TERRY LEE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
1 TRILLIUM WAY, CORBIN, KY 40701-8727
(606) 528-1212
Mailing address
1 TRILLIUM WAY, CORBIN, KY 40701-8727
(606) 526-8122
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA111
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SA111
CERTIFIED SURGICAL ASSISTANT LICENSE
KY
Enumeration date
12/06/2005
Last updated
09/09/2013
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