Provider Demographics
NPI:1639538366
Name:SMITH, AMY MELISSA (MSN, APN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MELISSA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APN, FNP-BC
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:MELISSA
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-222-1400
Mailing Address - Fax:615-222-1410
Practice Address - Street 1:4928 EDMONDSON PIKE STE 205
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4791
Practice Address - Country:US
Practice Address - Phone:615-222-1400
Practice Address - Fax:615-222-1410
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I504356OtherMEDICARE
TN5542747OtherBCBS OF TN
TNQ025038Medicaid