Healthcare Provider Details

I. General information

NPI: 1255242871
Provider Name (Legal Business Name): JENNY SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 JOYCE LN
WINCHESTER TN
37398-2568
US

IV. Provider business mailing address

188 GOURDNECK RD NW
TULLAHOMA TN
37388-6239
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-3826
  • Fax: 931-962-1168
Mailing address:
  • Phone: 931-797-5132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number180186
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: