Healthcare Provider Details

I. General information

NPI: 1265196232
Provider Name (Legal Business Name): BIANCA N SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MED TECH PKWY STE 200
JOHNSON CITY TN
37604-4001
US

IV. Provider business mailing address

131 GREENBRIAR LN APT 2
JOHNSON CITY TN
37615-3972
US

V. Phone/Fax

Practice location:
  • Phone: 423-232-6120
  • Fax: 833-450-6025
Mailing address:
  • Phone: 423-943-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30395
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: