Provider Demographics
NPI:1841527686
Name:SMITH, BRENDA G (NP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:G
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 1:1124 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-6527
Mailing Address - Country:US
Mailing Address - Phone:865-444-5059
Mailing Address - Fax:865-540-6740
Practice Address - Street 1:1124 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917
Practice Address - Country:US
Practice Address - Phone:865-444-5059
Practice Address - Fax:865-540-6740
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily