Provider Demographics
NPI:1013749571
Name:SMOTHERS, SHELBY NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:NICOLE
Last Name:SMOTHERS
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 1:151 HUNTERS RDG
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8132
Mailing Address - Country:US
Mailing Address - Phone:270-556-6515
Mailing Address - Fax:
Practice Address - Street 1:4720 VILLAGE SQUARE DR STE B
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6401
Practice Address - Country:US
Practice Address - Phone:270-554-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4025975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine