Provider Demographics
NPI:1083315006
Name:SMITH, JESSICA CARRIE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CARRIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 11TH AVE N APT 221
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-3640
Mailing Address - Country:US
Mailing Address - Phone:615-389-7187
Mailing Address - Fax:
Practice Address - Street 1:300 11TH AVE N APT 221
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-3640
Practice Address - Country:US
Practice Address - Phone:615-389-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000253810163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse