Provider Demographics
NPI:1710601133
Name:SMITH, TONI MICAH
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:MICAH
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FOX AND HOUND WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-8074
Mailing Address - Country:US
Mailing Address - Phone:423-532-8105
Mailing Address - Fax:
Practice Address - Street 1:135 FOX AND HOUND WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-8074
Practice Address - Country:US
Practice Address - Phone:423-532-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000096315164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse