Tara Nichole Smith, RN
Individual provider Active NPI Registered Nurse · Adolphus, KY
NPI 1003565680 · NPPES record last updated Mar 22, 2022
Key facts
- NPI
- 1003565680
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 1139739 (KY)
- Practice address
- 308 Blunt Ford Rd
Adolphus, KY 42120-8719 - Phone
- (270) 622-9418
- NPI assigned
- Mar 22, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1139739 | KY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 1139739 | KY | Yes |
Addresses
Primary practice location
308 Blunt Ford Rd
Adolphus, KY 42120-8719
Mailing address
308 Blunt Ford Rd
Adolphus, KY 42120-8719
Other providers in Adolphus, KY
All providers in Adolphus, KY · Registered Nurse in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.