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General NPI Number Information
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NPI Number | 1023653037
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Entity Type | Individual
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Provider Name | STACI SMITH FNP
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Gender | Female
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 2012 N MAIN ST
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2022
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Country | US
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Telephone | 931-703-0829
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Fax |
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Provider Business Mailing Address
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Address Line | 199 MORRIS LN
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City | WARTRACE
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State | TN
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Zip | 37183-3112
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Country | US
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Telephone | 931-703-0829
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 26843
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License Number State | TN
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