Individual
MR. JUSTIN WARREN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
200 ABRAHAM FLEXNER WAY, LOUISVILLE, KY 40202
(502) 587-4404
(502) 587-4156
Mailing address
100 E LIBERTY ST STE 800, LOUISVILLE, KY 40202-1428
(502) 540-3341
(502) 540-3393
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
166747
TN
363LF0000X
Family Nurse Practitioner
71001350A
IN
367500000X
Certified Registered Nurse Anesthetist
041315277
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
3004228
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200388540
—
IN
05
—
7100372420
—
KY
01
—
K1838900-KOHMG
KY MEDICARE
KY
Enumeration date
05/27/2005
Last updated
08/22/2018
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