Provider Demographics
NPI:1033119557
Name:SMITH, BARBARA JEAN (MSN, RN, FNP-BC,CDE)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:TN
Mailing Address - Zip Code:37820-0415
Mailing Address - Country:US
Mailing Address - Phone:865-475-6100
Mailing Address - Fax:865-475-6106
Practice Address - Street 1:1004 N HIGHWAY 92
Practice Address - Street 2:SUITE C
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-3687
Practice Address - Country:US
Practice Address - Phone:865-475-6100
Practice Address - Fax:865-475-6106
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7024363L00000X
TNRN101110363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33433961Medicaid
TN33433961Medicaid
TN33433961Medicare PIN