Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 12319 | TN |
NPI | 1194866186 |
---|---|
Provider Name | Christa Burkes Smith |
First Address | Memphis, TN 38111-3412 |
Second Address | Germantown, TN 38138-3904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2007 |
Last Update Date | 08/07/2007 |