Provider Demographics
NPI:1699283382
Name:SMITH, HEATHER MARIE (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
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 1:1351 SKINHOUSE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-7778
Mailing Address - Country:US
Mailing Address - Phone:270-932-5593
Mailing Address - Fax:
Practice Address - Street 1:112 S PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1533
Practice Address - Country:US
Practice Address - Phone:270-932-4284
Practice Address - Fax:270-932-4285
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily