Healthcare Provider Details

I. General information

NPI: 1194098145
Provider Name (Legal Business Name): KELLY SMITH BARNES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HAWKS RD STE 6
MARTIN TN
38237-2742
US

IV. Provider business mailing address

215 HAWKS RD STE 6
MARTIN TN
38237-2742
US

V. Phone/Fax

Practice location:
  • Phone: 731-281-7501
  • Fax: 731-281-7503
Mailing address:
  • Phone: 731-281-7501
  • Fax: 731-281-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007336
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN16412
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: