Provider Demographics
NPI:1033814439
Name:SMITH, SAMANTHA JO
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
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:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:ARTEMUS
Mailing Address - State:KY
Mailing Address - Zip Code:40903-0324
Mailing Address - Country:US
Mailing Address - Phone:606-627-2118
Mailing Address - Fax:
Practice Address - Street 1:2995 KY 225
Practice Address - Street 2:
Practice Address - City:ARTEMUS
Practice Address - State:KY
Practice Address - Zip Code:40903
Practice Address - Country:US
Practice Address - Phone:606-627-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1162534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse