Most Relevant Information
Provider Data
| NPI Number: | 1003565680 |
| Provider Name: | TARA NICHOLE SMITH RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 1139739 |
Most Important Dates
| Enumeration Date: | 03/22/2022 |
| Last Updated: | 03/22/2022 |
Provider Practice Location
308 BLUNT FORD RD
ADOLPHUS
KY
421208719
Practice Location Phone/Fax
| Phone: | 2706229418 |
| Fax: |
Provider Mailing Location
308 BLUNT FORD RD
ADOLPHUS
KY
421208719
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |