Healthcare Provider Details

I. General information

NPI: 1366513772
Provider Name (Legal Business Name): JAMES M SMITH MSN-CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18797 ALBERTA ST
ONEIDA TN
37841-2127
US

IV. Provider business mailing address

12752 KINGSTON PIKE STE E202
KNOXVILLE TN
37934-0948
US

V. Phone/Fax

Practice location:
  • Phone: 865-777-0909
  • Fax: 865-777-0910
Mailing address:
  • Phone: 865-777-0909
  • Fax: 865-777-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN11282
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN106433
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4873A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: