Provider Demographics
NPI:1679678932
Name:SMITH, ELAINE L (ARNP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:L
Last Name:SMITH
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 1:3580 LYON DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1210
Mailing Address - Country:US
Mailing Address - Phone:859-224-9581
Mailing Address - Fax:859-224-9497
Practice Address - Street 1:3580 LYON DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1210
Practice Address - Country:US
Practice Address - Phone:859-224-9581
Practice Address - Fax:859-224-9497
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4288P363L00000X, 363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78014255Medicaid
KY37903705OtherMEDICAID LAB GROUP
KYCB5773OtherRR MEDICARE GROUP
KY4000501OtherMEDICARE LAB GROUP
KYP00243304OtherRR MEDICARE PIN
KY37903705OtherMEDICAID LAB GROUP
KY78014255Medicaid