1346247186 NPI number — MRS. KERRI ANN MCCABE SMITH PA

Table of content: MRS. KERRI ANN MCCABE SMITH PA (NPI 1346247186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346247186 NPI number — MRS. KERRI ANN MCCABE SMITH PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCABE SMITH
Provider First Name:
KERRI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCABE
Provider Other First Name:
KERRI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346247186
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 KELLEY DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38242-5819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-644-2271
Provider Business Mailing Address Fax Number:
731-644-3980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 KELLEY DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38242-5819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-644-2271
Provider Business Practice Location Address Fax Number:
731-644-3980
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  1208 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1346247186 . This is a "NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1124048541 . This is a "GROUP NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4102404 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3663101 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4102410 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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