Provider Demographics
NPI:1992868343
Name:SMITH, PHYLLIS C (FNP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:C
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 1:10626 CHAPMAN HWY
Mailing Address - Street 2:P.O. BOX 309
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4703
Mailing Address - Country:US
Mailing Address - Phone:865-577-5231
Mailing Address - Fax:865-577-1539
Practice Address - Street 1:10626 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4703
Practice Address - Country:US
Practice Address - Phone:865-577-5231
Practice Address - Fax:865-577-1539
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN71129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3344525Medicaid
TN3149851OtherBCBS
TN3344525Medicare ID - Type Unspecified
TN3344525Medicaid