Provider Demographics
NPI:1164800629
Name:SMITH, SHEREE (ANP)
Entity Type:Individual
Prefix:
First Name:SHEREE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S MAIN ST
Mailing Address - Street 2:STE 1300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5513
Mailing Address - Country:US
Mailing Address - Phone:901-422-7617
Mailing Address - Fax:
Practice Address - Street 1:2075 PLEASANT PLAINS EXT RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6087
Practice Address - Country:US
Practice Address - Phone:731-984-8400
Practice Address - Fax:731-984-8305
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19872363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology