Provider Demographics
NPI:1457470643
Name:SMART, MICHELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SMART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 CAROLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-4671
Mailing Address - Country:US
Mailing Address - Phone:270-759-0915
Mailing Address - Fax:
Practice Address - Street 1:136 WELLS HALL
Practice Address - Street 2:MSU HEALTH SERVICES
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-3318
Practice Address - Country:US
Practice Address - Phone:270-809-3809
Practice Address - Fax:270-809-3540
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2755-P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily