Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 15595 | TN |
NPI | 1003112277 |
---|---|
Provider Name | Tabitha M Smith |
First Address | Woodbury, TN 37190-1441 |
Second Address | Woodbury, TN 37190-1441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2011 |
Last Update Date | 16/02/2016 |