Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 24339 | TN |
NPI | 1003300351 |
---|---|
Provider Name | Carly Michelle Smith |
First Address | Goodlettsville, TN 37072-3163 |
Second Address | Nashville, TN 37212-5318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2018 |
Last Update Date | 20/06/2019 |