Healthcare Provider Details

I. General information

NPI: 1619399169
Provider Name (Legal Business Name): MELISSA SMITH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 DINAH SHORE BLVD
WINCHESTER TN
37398-1107
US

IV. Provider business mailing address

1211 DINAH SHORE BLVD
WINCHESTER TN
37398-1107
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-6669
  • Fax: 931-967-6606
Mailing address:
  • Phone: 931-967-6669
  • Fax: 931-967-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0114396
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: