Provider Demographics
NPI:1790093284
Name:SMITH, JANINE KRISTEN (PA)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:KRISTEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:KRISTEN
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2595 CENTRAL AVENUE
Mailing Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES IN
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-260-8551
Mailing Address - Fax:901-260-8590
Practice Address - Street 1:2861 BROAD AVENUE
Practice Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112
Practice Address - Country:US
Practice Address - Phone:901-260-8450
Practice Address - Fax:901-260-8590
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521009Medicaid