Individual
AMANDA ELIZABETH SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
211 FOUNTAIN CT STE 120, LEXINGTON, KY 40509-2695
(859) 629-7245
(859) 629-7246
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7825
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
45030
KY
208000000X
Pediatrics Physician
45030
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000848561 (KOHMG)
ANTHEM BC/BS
KY
05
—
7100165640 (KOHMG)
—
KY
Enumeration date
02/26/2009
Last updated
07/11/2019
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