Provider Demographics
NPI:1740949767
Name:SMITH, ANNA KATHLEEN
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHLEEN
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 1:520 MARY ST STE 330
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1679
Mailing Address - Country:US
Mailing Address - Phone:812-426-9895
Mailing Address - Fax:
Practice Address - Street 1:520 MARY ST STE 330
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1679
Practice Address - Country:US
Practice Address - Phone:812-426-9895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator