Provider Demographics
NPI:1811371370
Name:SMITH, LEANN W (FNP)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-4323
Mailing Address - Country:US
Mailing Address - Phone:865-658-5454
Mailing Address - Fax:423-259-8662
Practice Address - Street 1:951 N BROAD ST
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-4323
Practice Address - Country:US
Practice Address - Phone:265-658-5454
Practice Address - Fax:423-259-8662
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10350I7304Medicare PIN