Provider Demographics
NPI:1730107392
Name:SMITH, JULIE A (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNETTE
Other - Last Name:RENNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:140 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1726
Mailing Address - Country:US
Mailing Address - Phone:931-783-5582
Mailing Address - Fax:931-526-6760
Practice Address - Street 1:438 N WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2455
Practice Address - Country:US
Practice Address - Phone:931-783-2616
Practice Address - Fax:931-783-2610
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN108544163W00000X
TN7294363LA2100X
TNAPN0000007294364SC2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
010695688OtherTAX ID
TN3374966OtherMEDICARE GROUP PIN
TN4156133OtherBC/BS
TN3374966OtherMEDICAID GROUP
TN3907421Medicaid
TN4026322OtherBC/BS GROUP
TN4026322OtherBC/BS GROUP
P70185Medicare UPIN