Provider Demographics
NPI:1083125140
Name:SMITH JOHNSON, ANDREA LAUREN (FNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LAUREN
Last Name:SMITH JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MOUNTAIN VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:TN
Mailing Address - Zip Code:37658-3062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 N STATE OF FRANKLIN RD STE 202
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6063
Practice Address - Country:US
Practice Address - Phone:423-929-7111
Practice Address - Fax:423-929-9448
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23135363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3703470Medicaid