Provider Demographics
NPI:1043035686
Name:SMYTHE, NICHOLAS KENNETH III (PHD IN PROGRESS)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:KENNETH
Last Name:SMYTHE
Suffix:III
Gender:M
Credentials:PHD IN PROGRESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 EAGLE LNDG
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-8659
Mailing Address - Country:US
Mailing Address - Phone:334-390-1795
Mailing Address - Fax:
Practice Address - Street 1:224 W D.L. INGRAM AVENUE, BLDG. 1408
Practice Address - Street 2:
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103
Practice Address - Country:US
Practice Address - Phone:334-390-1795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG