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General NPI Number Information
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NPI Number | 1992062020
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Entity Type | Individual
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Provider Name | MR. KEVIN SMITH
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Gender | Male
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 1900 EXETER RD
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City | GERMANTOWN
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State | TN
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Zip | 38138
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Country | US
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Telephone | 901-818-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 6910 7TH RD
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City | BARTLETT
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State | TN
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Zip | 38135-2568
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Country | US
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Telephone | 901-386-8539
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN0000158867
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APN 16753
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License Number State | TN
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