Healthcare Provider Details

I. General information

NPI: 1033119557
Provider Name (Legal Business Name): BARBARA JEAN SMITH MSN, RN, FNP-BC,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 N HIGHWAY 92 SUITE C
JEFFERSON CITY TN
37760-3687
US

IV. Provider business mailing address

PO BOX 415
NEW MARKET TN
37820-0415
US

V. Phone/Fax

Practice location:
  • Phone: 865-475-6100
  • Fax: 865-475-6106
Mailing address:
  • Phone: 865-475-6100
  • Fax: 865-475-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN7024
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN101110
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: