Healthcare Provider Details

I. General information

NPI: 1609334630
Provider Name (Legal Business Name): MALLORY LYNNE SMITH AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GREAT CIRCLE RD FL 3
NASHVILLE TN
37228-1317
US

IV. Provider business mailing address

501 GREAT CIRCLE RD FL 3
NASHVILLE TN
37228-1317
US

V. Phone/Fax

Practice location:
  • Phone: 800-367-5690
  • Fax:
Mailing address:
  • Phone: 615-436-9060
  • Fax: 615-235-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP140939
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4018626
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number95014580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: