Provider Demographics
NPI:1306250683
Name:SMILEY, PRISCILLA RENEE
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:RENEE
Last Name:SMILEY
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 1:302 MICHAEL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4867
Mailing Address - Country:US
Mailing Address - Phone:513-702-3423
Mailing Address - Fax:
Practice Address - Street 1:302 MICHAEL AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4867
Practice Address - Country:US
Practice Address - Phone:513-702-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2487152374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2487152Medicaid