Provider Demographics
NPI:1558148783
Name:SMITH, CHEYENNE C (BSN, RN, LMT)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:BSN, RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SAINT MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1162
Mailing Address - Country:US
Mailing Address - Phone:502-758-8654
Mailing Address - Fax:
Practice Address - Street 1:704 SPRING MEADOWS DR # C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3624
Practice Address - Country:US
Practice Address - Phone:502-758-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY286521225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist