Provider Demographics
NPI:1437030186
Name:SMITH, JERRY BENTLEY
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:BENTLEY
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 DELONG RD
Mailing Address - Street 2:
Mailing Address - City:HAGERHILL
Mailing Address - State:KY
Mailing Address - Zip Code:41222-9015
Mailing Address - Country:US
Mailing Address - Phone:606-738-6133
Mailing Address - Fax:
Practice Address - Street 1:505 PRISON CONNECTOR
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:KY
Practice Address - Zip Code:41171-7010
Practice Address - Country:US
Practice Address - Phone:606-738-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA00687225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty