Provider Demographics
NPI:1245251974
Name:SMITH, CAROL GREEN (ARNP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:GREEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9672 WYMART AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-2415
Mailing Address - Country:US
Mailing Address - Phone:513-521-1451
Mailing Address - Fax:
Practice Address - Street 1:1000 S FORT THOMAS AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2305
Practice Address - Country:US
Practice Address - Phone:859-572-6781
Practice Address - Fax:859-572-6724
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1109295163W00000X
OHRN172647163W00000X
KY4867S364SP0809X
OHNS01372364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult