Provider Demographics
NPI:1922785641
Name:SMITH, CHELSEA FORREST (FNP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:FORREST
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:FORREST
Other - Last Name:NICLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1621 W MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2967
Mailing Address - Country:US
Mailing Address - Phone:423-492-7100
Mailing Address - Fax:
Practice Address - Street 1:1621 W MORRIS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2967
Practice Address - Country:US
Practice Address - Phone:423-492-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ085560Medicaid