Provider Demographics
NPI:1801375779
Name:SMITH, MEREDYTH TATE (APRN)
Entity Type:Individual
Prefix:
First Name:MEREDYTH
Middle Name:TATE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MEREDYTH
Other - Middle Name:TATE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:800 ROSE ST ROACH CANCER CTR 1ST FL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-257-6006
Mailing Address - Fax:859-257-6002
Practice Address - Street 1:800 ROSE ST ROACH CANCER CTR 1ST FL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-9416
Practice Address - Country:US
Practice Address - Phone:859-257-6006
Practice Address - Fax:859-257-6002
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012596363LA2100X, 363LG0600X
FLAPRN11007268363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology