Provider Demographics
NPI:1578217279
Name:SMITH, STACY R (MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 MURFREESBORO RD STE 307
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1312
Mailing Address - Country:US
Mailing Address - Phone:615-790-2548
Mailing Address - Fax:
Practice Address - Street 1:1113 MURFREESBORO RD STE 307
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1312
Practice Address - Country:US
Practice Address - Phone:615-790-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMS7373816OtherDEA