Healthcare Provider Details

I. General information

NPI: 1316647886
Provider Name (Legal Business Name): RYLEE CLAIRE SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 FRONT ST
HENDERSON TN
38340-2313
US

IV. Provider business mailing address

111 FRONT ST
HENDERSON TN
38340-2313
US

V. Phone/Fax

Practice location:
  • Phone: 731-989-2829
  • Fax: 731-520-0230
Mailing address:
  • Phone: 731-989-2829
  • Fax: 731-520-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5571
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: