Provider Demographics
NPI:1508411562
Name:SMITH, KIMBERLY LANE (APRN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LANE
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 1:202 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:KY
Mailing Address - Zip Code:41095
Mailing Address - Country:US
Mailing Address - Phone:859-567-2754
Mailing Address - Fax:859-567-5108
Practice Address - Street 1:202 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095
Practice Address - Country:US
Practice Address - Phone:859-567-2754
Practice Address - Fax:859-567-5108
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily