Provider Demographics
NPI:1982362307
Name:SMITH, TERRA SKY RHOADES (CNM)
Entity type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:SKY RHOADES
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:TERRA
Other - Middle Name:SKY
Other - Last Name:RHOADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5066
Practice Address - Street 1:4123 DUTCHMANS LN STE 601
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4725
Practice Address - Country:US
Practice Address - Phone:024-239-5955
Practice Address - Fax:502-719-0161
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0997139367A00000X
KY4017488367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7101010220Medicaid
IN300095361Medicaid
COAPN.0997139-CNMOtherDEPARTMENT OF REGULATORY AGENCIES