Healthcare Provider Details

I. General information

NPI: 1811865967
Provider Name (Legal Business Name): KRISTIN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 S WILLOW AVE STE A
COOKEVILLE TN
38501-3892
US

IV. Provider business mailing address

768 S WILLOW AVE STE A
COOKEVILLE TN
38501-3892
US

V. Phone/Fax

Practice location:
  • Phone: 931-559-6900
  • Fax: 931-548-6909
Mailing address:
  • Phone: 931-559-6900
  • Fax: 931-548-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number40301
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: