Provider Demographics
NPI:1790736817
Name:SMITH, HOLLY M (PA-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:M
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:859-278-0159
Practice Address - Street 1:1401 HARRODSBURG RD STE B275
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1775
Practice Address - Country:US
Practice Address - Phone:859-278-2334
Practice Address - Fax:859-278-0159
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA717363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100033440Medicaid
KYP00472281OtherRAILROAD MEDICARE
KY7100033440Medicaid
KY0542715Medicare PIN
KY1267235Medicare ID - Type Unspecified