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General NPI Number Information
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NPI Number | 1275063257
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Entity Type | Individual
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Provider Name | AMANDA JO SMITH-RODRIGUEZ MSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 1059 NEAL ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-0946
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Country | US
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Telephone | 931-507-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 1582 RICKMAN RD
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City | LIVINGSTON
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State | TN
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Zip | 38570-6056
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Country | US
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Telephone | 931-397-0495
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 161705
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F05170606
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License Number State | TN
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