Provider Demographics
NPI:1477609600
Name:SMITH, ANTHONY GRIFFITH (ARNP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:GRIFFITH
Last Name:SMITH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NEWCOMB AVE
Mailing Address - Street 2:SUITE 2C & D
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-2725
Mailing Address - Country:US
Mailing Address - Phone:606-256-4148
Mailing Address - Fax:606-256-7785
Practice Address - Street 1:140 NEWCOMB AVE
Practice Address - Street 2:SUITE 2C & D
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2725
Practice Address - Country:US
Practice Address - Phone:606-256-4148
Practice Address - Fax:606-256-7785
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1934882363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305528100Medicaid
KYK052460Medicare PIN