Provider Demographics
NPI:1235737354
Name:SMITH, ADRIENNE (PA)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2555 MERIDIAN BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6670
Mailing Address - Country:US
Mailing Address - Phone:161-536-7144
Mailing Address - Fax:
Practice Address - Street 1:5200 PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3505
Practice Address - Country:US
Practice Address - Phone:901-969-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant