Individual
JIMMY REECE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
384 MOUNT EVEREST WAY, BOWLING GREEN, KY 42104-8569
(615) 719-0458
Mailing address
1143 FAIRWAY ST STE 103, BOWLING GREEN, KY 42103-2452
(407) 347-4536
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1099382
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4026120
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1099382
KY BOARD OF NURSING
KY
Enumeration date
07/04/2022
Last updated
12/04/2024
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