Provider Demographics
NPI:1699714220
Name:SMITH, RODNEY TRAVIS (NP)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:TRAVIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-0518
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:SUITE 2
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:2006-06-06
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4069P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00259831OtherRAILROAD MEDICARE
KY78011186Medicaid
KY0976504Medicare PIN
KY0549909Medicare PIN
P96110Medicare UPIN