Provider Demographics
NPI:1346247186
Name:MCCABE SMITH, KERRI ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:ANN
Last Name:MCCABE SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KERRI
Other - Middle Name:ANN
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1015 KELLEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5819
Mailing Address - Country:US
Mailing Address - Phone:731-644-2271
Mailing Address - Fax:731-644-3980
Practice Address - Street 1:1015 KELLEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5819
Practice Address - Country:US
Practice Address - Phone:731-644-2271
Practice Address - Fax:731-644-3980
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1208363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1346247186OtherNPI
TN1124048541OtherGROUP NPI
TN4102404OtherBCBSTN
TN3663101Medicaid
TN4102410OtherBCBSTN
TN4102404OtherBCBSTN
TN3663101Medicaid
TN1124048541OtherGROUP NPI
TNQ33643Medicare UPIN