Provider Demographics
NPI:1962377739
Name:SMITH, CHELSIE
Entity type:Individual
Prefix:
First Name:CHELSIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 DARBY CREEK RD STE C
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1603
Mailing Address - Country:US
Mailing Address - Phone:859-368-2567
Mailing Address - Fax:859-788-3905
Practice Address - Street 1:503 DARBY CREEK RD STE C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1603
Practice Address - Country:US
Practice Address - Phone:859-368-2567
Practice Address - Fax:859-788-3905
Is Sole Proprietor?:No
Enumeration Date:2025-10-09
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4045090363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health