Provider Demographics
NPI:1073087797
Name:SMITH, TINA A (APRN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:638 E COLLEGE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-2363
Mailing Address - Country:US
Mailing Address - Phone:606-318-3500
Mailing Address - Fax:606-318-3506
Practice Address - Street 1:638 E COLLEGE AVE STE B
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2363
Practice Address - Country:US
Practice Address - Phone:606-318-3500
Practice Address - Fax:606-318-3503
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3013143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily