1629249750 NPI number — BENJAMIN ALLAN SMALLHEER PHD, RN, ACNP-BC

Table of content: BENJAMIN ALLAN SMALLHEER PHD, RN, ACNP-BC (NPI 1629249750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629249750 NPI number — BENJAMIN ALLAN SMALLHEER PHD, RN, ACNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMALLHEER
Provider First Name:
BENJAMIN
Provider Middle Name:
ALLAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, RN, ACNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629249750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 GREAT CIRCLE RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37228-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-222-3449
Provider Business Mailing Address Fax Number:
615-222-5322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4220 HARDING PIKE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-222-3449
Provider Business Practice Location Address Fax Number:
615-222-5322
Provider Enumeration Date:
03/17/2008

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: 363LA2100X , with the licence number:  10818 , 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: 4321885 . This is a "BLUE CROSS-BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P01039022 . This is a "RR MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1527495 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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