Provider Demographics
NPI:1043285828
Name:SMITH, TABETHA LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:TABETHA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4184
Mailing Address - Country:US
Mailing Address - Phone:910-763-1960
Mailing Address - Fax:910-763-1961
Practice Address - Street 1:3175 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4184
Practice Address - Country:US
Practice Address - Phone:910-763-1960
Practice Address - Fax:910-763-1961
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily