Provider Demographics
NPI:1659098358
Name:SMITH, CAREN L (LPN)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 AQUA WAY
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-4816
Mailing Address - Country:US
Mailing Address - Phone:931-316-3716
Mailing Address - Fax:
Practice Address - Street 1:3100 CRISP SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-5238
Practice Address - Country:US
Practice Address - Phone:931-939-5046
Practice Address - Fax:931-939-5055
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93283164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse