Provider Demographics
NPI:1225741077
Name:SMITH, BLAKELEE PAIGE (MSN, APRN, AGPCNP-BC)
Entity Type:Individual
Prefix:MS
First Name:BLAKELEE PAIGE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N WASHINGTON AVE STE 265
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2697
Mailing Address - Country:US
Mailing Address - Phone:931-260-0327
Mailing Address - Fax:
Practice Address - Street 1:315 N WASHINGTON AVE STE 265
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2697
Practice Address - Country:US
Practice Address - Phone:931-260-0327
Practice Address - Fax:931-901-1303
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN236809163W00000X
TN33231363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse