Healthcare Provider Details

I. General information

NPI: 1912841479
Provider Name (Legal Business Name): ALYSSA SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W COMMERCIAL AVE
MONTEREY TN
38574-1107
US

IV. Provider business mailing address

1011 SUNK CANE RD
CRAWFORD TN
38554-3906
US

V. Phone/Fax

Practice location:
  • Phone: 931-839-6642
  • Fax:
Mailing address:
  • Phone: 931-337-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number41434
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: