Provider Demographics
NPI:1326367533
Name:SMITH, DEBORAH (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
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 1:332 W BROADWAY STE 216
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2131
Mailing Address - Country:US
Mailing Address - Phone:502-296-5440
Mailing Address - Fax:844-269-9707
Practice Address - Street 1:332 W BROADWAY STE 216
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2131
Practice Address - Country:US
Practice Address - Phone:502-296-5440
Practice Address - Fax:844-269-9707
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006795363LF0000X
KY30066795363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100157930Medicaid
KY7100157930Medicaid