1629111091 NPI NUMBER - TINA CHA SMITH
Summary
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NPI Number |
1629111091 |
| Entity Type Code |
Individual |
| Provider Legal Name |
TINA CHA SMITH |
| Provider Business Practice Location Address |
107 CRANES ROOST CT
ELIZABETHTOWN, KY
ZIP 42701
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| Practice Location Phone Number |
(270) 765-2605 |
| Provider Taxonomy Code |
163WP0808X - Registered Nurse |
| Specialization |
Psych/Mental Health |
| Provider Enumeration Date |
2/15/2007 |
| Last Update Date |
7/8/2007 |
NPI Number 1629111091 is assigned to an individual registered under the provider name TINA CHA SMITH .
The NPPES NPI record indicates the provider is a female.
The provider is physically located at:
107 CRANES ROOST CT
ELIZABETHTOWN, KY
ZIP 42701-650
Phone: (270) 765-2605
Fax: (270) 234-8572
The enumeration date for this NPI number is 2/15/2007 and was last updated on 7/8/2007 .
Map - Location of Practice
Taxonomy Codes
The following information regarding the scope of practice of this provider is available:
| 1 |
163WP0808X |
Registered Nurse |
Psych/Mental Health |
1108131 |
KY |
View Code |
Other (Legacy) Identifiers
The following legacy identifiers for this provider are available:
NPI Record
| 1 |
NPI |
1629111091 |
| 2 |
Entity Type Code |
1 |
| 3 |
Provider Last Name Legal Name |
SMITH |
| 4 |
Provider First Name |
TINA |
| 5 |
Provider Middle Name |
CHA |
| 6 |
Provider First Line Business Practice Location Address |
107 CRANES ROOST CT |
| 7 |
Provider Business Practice Location Address City Name |
ELIZABETHTOWN |
| 8 |
Provider Business Practice Location Address State Name |
KY |
| 9 |
Provider Business Practice Location Address Postal Code |
427013650 |
| 10 |
Provider Business Practice Location Address Country Code If outside U S |
US |
| 11 |
Provider Business Practice Location Address Telephone Number |
2707652605 |
| 12 |
Provider Business Practice Location Address Fax Number |
2702348572 |
| 13 |
Provider Enumeration Date |
2/15/2007 |
| 14 |
Last Update Date |
7/8/2007 |
| 15 |
Provider Gender Code |
F |
| 16 |
Healthcare Provider Taxonomy Code 1 |
163WP0808X |
| 17 |
Provider License Number 1 |
1108131 |
| 18 |
Provider License Number State Code 1 |
KY |
| 19 |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
| 20 |
Other Provider Identifier 1 |
30605018 |
| 21 |
Other Provider Identifier Type Code 1 |
05 |
| 22 |
Other Provider Identifier State 1 |
KY |
| 23 |
Is Sole Proprietor |
N |
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This page was last updated on: 5/14/2013
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.