Provider Demographics
NPI:1104835859
Name:SMITH, ROBIN KAY (APRN)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:
Practice Address - Street 1:2750 BATTLEFIELD MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-8332
Practice Address - Country:US
Practice Address - Phone:859-986-0302
Practice Address - Fax:859-986-0315
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78009503Medicaid
KY78009503Medicaid
KY31001118Medicaid
KYP400026180Medicare PIN
KYP100024105Medicare PIN
KYP76322Medicare UPIN
KYK096793Medicare PIN