Provider Demographics
NPI:1235267907
Name:SMITH, HOLLY BETH
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:BETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SEOCND AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:TN
Mailing Address - Zip Code:38469
Mailing Address - Country:US
Mailing Address - Phone:931-853-5097
Mailing Address - Fax:
Practice Address - Street 1:2379 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4810
Practice Address - Country:US
Practice Address - Phone:931-762-9406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide