Provider Demographics
NPI:1518099530
Name:SMITH, JULIE ANN (MSN,ACNP, BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN,ACNP, BC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:ATKEISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1056 E RAINES RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6337
Mailing Address - Country:US
Mailing Address - Phone:901-300-5777
Mailing Address - Fax:901-422-6092
Practice Address - Street 1:1056 E RAINES RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6337
Practice Address - Country:US
Practice Address - Phone:901-300-5777
Practice Address - Fax:901-422-6092
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000080499163WC0200X
MS810295363LA2100X
TNAPN0000010879363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515130Medicaid
TN103I506321Medicare PIN