Provider Demographics
NPI:1225028897
Name:SMITH, GARY A (ARNP)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:ARNP
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 636961
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6961
Mailing Address - Country:US
Mailing Address - Phone:513-981-5130
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:1710 HWY 121 N. BYPASS
Practice Address - Street 2:SUITE I
Practice Address - City:MURRY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-226-1118
Practice Address - Fax:270-226-1119
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003886363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000732995OtherBCBS
KY7100157310Medicaid
KYP00956479OtherRAILROAD MEDICARE
KY000000732995OtherBCBS
KYP00956479OtherRAILROAD MEDICARE
KY7100157310Medicaid
KY1327015Medicare PIN