Provider Demographics
NPI:1841448339
Name:SMITH, MELINDA RAE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 TREUHAFT BLVD
Mailing Address - Street 2:STE 3B
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7361
Mailing Address - Country:US
Mailing Address - Phone:606-545-0400
Mailing Address - Fax:606-545-0433
Practice Address - Street 1:215 TREUHAFT BLVD
Practice Address - Street 2:STE 3B
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7361
Practice Address - Country:US
Practice Address - Phone:606-545-0400
Practice Address - Fax:606-545-0433
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5727P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily