Provider Demographics
NPI:1407280795
Name:SMITH, CHARITY M (FNP)
Entity Type:Individual
Prefix:MS
First Name:CHARITY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4341
Mailing Address - Country:US
Mailing Address - Phone:423-476-2464
Mailing Address - Fax:423-476-1008
Practice Address - Street 1:4021 KEITH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4341
Practice Address - Country:US
Practice Address - Phone:423-476-2464
Practice Address - Fax:423-476-1008
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily