Provider Demographics
NPI:1831621663
Name:SMITH, ALANNA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:ALANNA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
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 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:100 LONDON MOUNTAIN VIEW DR FL 1
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6668
Practice Address - Country:US
Practice Address - Phone:859-275-5229
Practice Address - Fax:859-977-2683
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001257782OtherANTHEM PROVIDER ID NUMBER
258837OtherSIHO PROVIDER ID NUMBER
KY1880292OtherWELLCARE OF KENTUCKY PROVIDER ID NUMBER
KYPDZ000000088344OtherAETNA BETTER HEALTH OF KENTUCKY PROVIDER ID NUMBER
IN300024284Medicaid
7358100OtherCIGNA PROVIDER ID NUMBER
CS1914200118OtherCARESOURCE PROVIDER ID NUMBER
KYP02219541OtherRAILROAD MEDICARE
6057412OtherAETNA PROVIDER ID NUMBER
10502186OtherPRIME HEALTH SERVICES PROVIDER ID NUMBER
6681964OtherUNITED HEALTHCARE PROVIDER ID NUMBER
KY7100477480Medicaid