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NPI Code Detail

MEDICARE: STEPHANIE DENISE SMITH FNP

MEDICARE: STEPHANIE DENISE SMITH FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner23338TN

General Provider Information

NPI Number : 1518473123
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE DENISE SMITH FNP
Provider Business Mailing Address
First Line : 36 PEMBERTON CV
Second Line :
City : JACKSON
State : TN
Zip : 38305-5514
Country : US
Telephone Number : 731-394-1145
Fax Number :
Provider Business Practice Location Address
First Line : 308 LAKE DR
Second Line :
City : SOMERVILLE
State : TN
Zip : 38068-9716
Country : US
Telephone Number : 731-394-1145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2017
Last Update Date : 03/28/2022

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Directions to “ STEPHANIE DENISE SMITH FNP” Practice Location

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