Provider Demographics
NPI:1083775464
Name:NESMITH, CHAD B
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:B
Last Name:NESMITH
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 1:3750 RALPH AVE APT 127
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2204
Mailing Address - Country:US
Mailing Address - Phone:615-917-4972
Mailing Address - Fax:
Practice Address - Street 1:3750 RALPH AVE APT 127
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2204
Practice Address - Country:US
Practice Address - Phone:615-917-4972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17737101YP2500X
CO19242101YP2500X
KY283131101YP2500X
AL1596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional