Provider Demographics
NPI:1265139562
Name:SMITH, RACHEL MALIA (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MALIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7234 TAZEWELL PIKE
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-3550
Mailing Address - Country:US
Mailing Address - Phone:865-213-7132
Mailing Address - Fax:865-213-7133
Practice Address - Street 1:7234 TAZEWELL PIKE
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-3550
Practice Address - Country:US
Practice Address - Phone:865-213-7132
Practice Address - Fax:865-213-7133
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13229640-1206363A00000X
TN5760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant