Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 23135 | TN |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 23135 | TN |
NPI | 1083125140 |
---|---|
Provider Name | Andrea Lauren Smith |
First Address | Hampton, TN 37658-3062 |
Second Address | Johnson City, TN 37604-6063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2017 |
Last Update Date | 02/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3703470 | (05) | TN |