Provider Demographics
NPI:1821039348
Name:SMITH, DONNA J (NP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:J
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 1:2012 CHILHOWEE MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5285
Mailing Address - Country:US
Mailing Address - Phone:865-981-8838
Mailing Address - Fax:865-380-8868
Practice Address - Street 1:2012 CHILHOWEE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5285
Practice Address - Country:US
Practice Address - Phone:865-981-8838
Practice Address - Fax:865-380-8868
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00344560OtherRAILROAD MEDICARE
TN4122939OtherBCBS OF TENNESSEE
TN3643824Medicare PIN
TN4122939OtherBCBS OF TENNESSEE