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NPI Code Detail

MEDICARE: DERRICK ANDREA SMITH LPN

MEDICARE: DERRICK ANDREA SMITH LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse91683TN

General Provider Information

NPI Number : 1174413207
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK ANDREA SMITH LPN
Provider Business Mailing Address
First Line : 8891 W TURNBERRY PL APT 204
Second Line :
City : MEMPHIS
State : TN
Zip : 38125-2541
Country : US
Telephone Number : 901-724-3023
Fax Number :
Provider Business Practice Location Address
First Line : 3000 GETWELL RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38118-2205
Country : US
Telephone Number : 901-422-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2025
Last Update Date : 07/09/2025

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Directions to “ DERRICK ANDREA SMITH LPN” Practice Location

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