1033119557 NPI number — BARBARA JEAN SMITH MSN, RN, FNP-BC,CDE

Table of content: BARBARA JEAN SMITH MSN, RN, FNP-BC,CDE (NPI 1033119557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033119557 NPI number — BARBARA JEAN SMITH MSN, RN, FNP-BC,CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
BARBARA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, FNP-BC,CDE
Provider Gender Code:
F

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:
1033119557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 415
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW MARKET
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37820-0415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-475-6100
Provider Business Mailing Address Fax Number:
865-475-6106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 N HIGHWAY 92
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37760-3687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-475-6100
Provider Business Practice Location Address Fax Number:
865-475-6106
Provider Enumeration Date:
07/27/2005

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: 363L00000X , with the licence number:  APN7024 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: RN101110 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 33433961 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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