Provider Demographics
NPI:1912186636
Name:MELISSA SMITH, D.O., PSC
Entity Type:Organization
Organization Name:MELISSA SMITH, D.O., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-325-8364
Mailing Address - Street 1:2222 WINCHESTER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7847
Mailing Address - Country:US
Mailing Address - Phone:606-325-8364
Mailing Address - Fax:606-327-8893
Practice Address - Street 1:2222 WINCHESTER AVE STE C
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7847
Practice Address - Country:US
Practice Address - Phone:606-325-8364
Practice Address - Fax:606-327-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY029432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY02943OtherLICENSE
KYBS8979126OtherDEA
KYBS8979126OtherDEA