Provider Demographics
NPI:1699026856
Name:SMITH, ELAINE MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
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 1:3001 W HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40032-0001
Mailing Address - Country:US
Mailing Address - Phone:502-222-9441
Mailing Address - Fax:502-222-7760
Practice Address - Street 1:3001 W HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40032-0001
Practice Address - Country:US
Practice Address - Phone:502-222-9441
Practice Address - Fax:502-222-7760
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1072757163W00000X
KY3007703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse