Healthcare Provider Details

I. General information

NPI: 1194866186
Provider Name (Legal Business Name): CHRISTA BURKES SMITH RN, MSN, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7691 POPLAR AVE
GERMANTOWN TN
38138-3904
US

IV. Provider business mailing address

86 E LAFAYETTE CIR
MEMPHIS TN
38111-3412
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-6418
  • Fax:
Mailing address:
  • Phone: 901-323-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number12319
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: