Provider Demographics
NPI:1376279448
Name:SMITH, MACY GRACE
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:GRACE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 KY 225
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7759
Mailing Address - Country:US
Mailing Address - Phone:606-619-4086
Mailing Address - Fax:606-545-9555
Practice Address - Street 1:415 KY 225
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7759
Practice Address - Country:US
Practice Address - Phone:606-619-4086
Practice Address - Fax:606-545-9555
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator