Provider Demographics
NPI:1285268060
Name:SMITH, DONNA RAY
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:RAY
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 1:3012 BOAIRES LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2428
Mailing Address - Country:US
Mailing Address - Phone:502-608-2707
Mailing Address - Fax:
Practice Address - Street 1:3012 BOAIRES LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2428
Practice Address - Country:US
Practice Address - Phone:502-608-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide