Healthcare Provider Details

I. General information

NPI: 1548879067
Provider Name (Legal Business Name): KENDRA DE'VON SMITH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 19TH ST STE 401
KNOXVILLE TN
37916-1831
US

IV. Provider business mailing address

501 19TH ST STE 401
KNOXVILLE TN
37916-1831
US

V. Phone/Fax

Practice location:
  • Phone: 865-331-2020
  • Fax: 865-331-1976
Mailing address:
  • Phone: 865-331-2020
  • Fax: 865-331-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN0000027039
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: