Provider Demographics
NPI:1750478871
Name:SMITH, CASSIE T (CRNA)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:T
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1206 TURNBULL RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-4805
Mailing Address - Country:US
Mailing Address - Phone:615-944-8558
Mailing Address - Fax:
Practice Address - Street 1:1206 TURNBULL RD
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-4805
Practice Address - Country:US
Practice Address - Phone:615-944-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA95000931367500000X
TN76036367500000X
CARN95163666163W00000X
TNAPN7190363LF0000X
TN7190367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74012634Medicaid
TN4141409OtherBCBS OF TN
TN3638048Medicare PIN
TN4141409OtherBCBS OF TN