Provider Demographics
NPI:1760442263
Name:SMITH, PATRICIA WEBB (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:WEBB
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 1:229 W WALNUT ST
Mailing Address - Street 2:PO BOX 484
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2223
Mailing Address - Country:US
Mailing Address - Phone:270-251-3666
Mailing Address - Fax:270-251-3506
Practice Address - Street 1:229 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2223
Practice Address - Country:US
Practice Address - Phone:270-251-3666
Practice Address - Fax:270-251-3506
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2699S364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78017076Medicaid
KYS92280Medicare UPIN
KY78017076Medicaid