Provider Demographics
NPI:1205855194
Name:SMITH, JANE ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:2333 ALUMNI PARK PLAZA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4012
Mailing Address - Country:US
Mailing Address - Phone:859-218-5677
Mailing Address - Fax:859-257-7899
Practice Address - Street 1:2400 GREATSTONE PT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-323-2181
Practice Address - Fax:859-257-7706
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3004394363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78012820Medicaid
KYQ33625Medicare UPIN
KY78012820Medicaid