Provider Demographics
NPI:1659302180
Name:SMITH, EVELYN W (FNP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 UNDERPASS DR
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-5885
Mailing Address - Country:US
Mailing Address - Phone:423-569-5454
Mailing Address - Fax:423-569-5858
Practice Address - Street 1:281 UNDERPASS DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-5885
Practice Address - Country:US
Practice Address - Phone:423-569-5454
Practice Address - Fax:423-569-5858
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000056665163WC1500X
TNAPN 5692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3344058Medicaid
TN4123024OtherBCBS OF TN
TN4123024OtherBCBS OF TN
TN103I500668Medicare PIN
TN334058Medicare PIN