Provider Demographics
NPI:1376789339
Name:SMELTZER, VICKIE DARLENE (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:DARLENE
Last Name:SMELTZER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MOORE CIRCLE RD NW
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:TN
Mailing Address - Zip Code:37310-5026
Mailing Address - Country:US
Mailing Address - Phone:423-618-2611
Mailing Address - Fax:
Practice Address - Street 1:190 MOORE CIRCLE RD NW
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:TN
Practice Address - Zip Code:37310-5026
Practice Address - Country:US
Practice Address - Phone:423-618-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000074322163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant