Provider Demographics
NPI:1073878427
Name:SMEATHERS, PANAYIOTA AGAMEMNONOS (MSN, MPH, CNM, FNP-C)
Entity Type:Individual
Prefix:
First Name:PANAYIOTA
Middle Name:AGAMEMNONOS
Last Name:SMEATHERS
Suffix:
Gender:F
Credentials:MSN, MPH, CNM, FNP-C
Other - Prefix:
Other - First Name:PANAYIOTA
Other - Middle Name:MICHAEL
Other - Last Name:AGAMEMNONOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, MPH, CNM, FNP-C
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-587-4515
Mailing Address - Fax:
Practice Address - Street 1:3920 DUTCHMANS LN STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-587-4515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005517A363L00000X
TN16796363LF0000X, 367A00000X
KY3017265363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100370750Medicaid