Provider Demographics
NPI:1801589627
Name:SKIN & AESTHETICS TN
Entity type:Organization
Organization Name:SKIN & AESTHETICS TN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKELEE
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:931-260-0327
Mailing Address - Street 1:315 N WASHINGTON AVE STE 265
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2697
Mailing Address - Country:US
Mailing Address - Phone:931-260-0327
Mailing Address - Fax:
Practice Address - Street 1:315 N WASHINGTON AVE STE 265
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2697
Practice Address - Country:US
Practice Address - Phone:931-260-0327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty