Provider Demographics
NPI:1518041961
Name:SMITH, SCOTT E (CRNA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440246
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0246
Mailing Address - Country:US
Mailing Address - Phone:615-620-2333
Mailing Address - Fax:615-620-2323
Practice Address - Street 1:315 OAK ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1728
Practice Address - Country:US
Practice Address - Phone:931-823-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN10758367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74011354Medicaid
TN01072314OtherAMERIGROUP COMMUNITY CARE - TNCARE ONLY
TN3634916Medicaid
TN4111682OtherBC/BS TN -NETWORKS P, S, TENNSELECT, BLUECARE
TN3634916Medicare PIN