Healthcare Provider Details

I. General information

NPI: 1346247186
Provider Name (Legal Business Name): KERRI ANN MCCABE SMITH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRI ANN MCCABE P.A.

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 KELLEY DR SUITE 200
PARIS TN
38242-5819
US

IV. Provider business mailing address

1015 KELLEY DR SUITE 200
PARIS TN
38242-5819
US

V. Phone/Fax

Practice location:
  • Phone: 731-644-2271
  • Fax: 731-644-3980
Mailing address:
  • Phone: 731-644-2271
  • Fax: 731-644-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1208
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: