Provider Demographics
NPI:1093126450
Name:SMITH, SARA (NP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 GERI ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2392
Mailing Address - Country:US
Mailing Address - Phone:931-762-9797
Mailing Address - Fax:
Practice Address - Street 1:325 GERI ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2392
Practice Address - Country:US
Practice Address - Phone:931-762-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000018614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily