TINA CHA SMITH - NPI NUMBER 1629111091

Summary

Provider Name: TINA CHA SMITH

NPI Number: 1629111091

Clasification: Registered Nurse (163WP0808X)

Specialization: Psych/Mental Health

Address:
107 CRANES ROOST CT
ELIZABETHTOWN, KY
ZIP 42701

Phone Number: (270) 765-2605



Detailed Information

Tina Cha Smith is a psych/mental health registered nurse in Elizabethtown, KY. The assigned NPI number for this provider is 1629111091 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

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

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 163WP0808X Registered Nurse Psych/Mental Health 1108131 KY Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 30605018 MEDICAID KY

NPI Record

No. Field Name Field Value
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: 10/12/2014
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.