Provider Demographics
NPI:1821401985
Name:SMITH, CHRISTINA SIMMONS (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SIMMONS
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 1:364 S FRONT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-4160
Mailing Address - Country:US
Mailing Address - Phone:901-505-2017
Mailing Address - Fax:901-509-3256
Practice Address - Street 1:364 S FRONT ST STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-4160
Practice Address - Country:US
Practice Address - Phone:901-292-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily