Provider Demographics
NPI:1770637464
Name:SMITH, MARTHA ANN (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2934
Mailing Address - Country:US
Mailing Address - Phone:901-273-1190
Mailing Address - Fax:901-273-1195
Practice Address - Street 1:1469 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2934
Practice Address - Country:US
Practice Address - Phone:901-273-1190
Practice Address - Fax:901-273-1195
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5737363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology