Provider Demographics
NPI:1083069686
Name:FORD, MARY SMILEY (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SMILEY
Last Name:FORD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHLEEN
Other - Last Name:SMILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3709 MAYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-3440
Mailing Address - Country:US
Mailing Address - Phone:615-319-4878
Mailing Address - Fax:
Practice Address - Street 1:185 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2404
Practice Address - Country:US
Practice Address - Phone:931-967-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN182841163W00000X
TN22147367500000X
TN110853367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse