Provider Demographics
NPI:1811220171
Name:SMITH, SUZANN (APRN)
Entity Type:Individual
Prefix:
First Name:SUZANN
Middle Name:
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 1:11217 HIGHWAY 421 S
Mailing Address - Street 2:
Mailing Address - City:TYNER
Mailing Address - State:KY
Mailing Address - Zip Code:40486-8352
Mailing Address - Country:US
Mailing Address - Phone:606-598-5104
Mailing Address - Fax:606-712-1200
Practice Address - Street 1:56 MARIE LANGDON DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6329
Practice Address - Country:US
Practice Address - Phone:606-599-4080
Practice Address - Fax:606-712-1200
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006246363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
48136OtherLICENSE