Provider Demographics
NPI:1124485388
Name:SMITH, MEGAN CHRISTINE (FNP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CHRISTINE
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 1:10810 PARKSIDE DR STE 305
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1986
Mailing Address - Country:US
Mailing Address - Phone:865-392-3971
Mailing Address - Fax:865-392-3972
Practice Address - Street 1:10810 PARKSIDE DR STE 305
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1986
Practice Address - Country:US
Practice Address - Phone:865-392-3971
Practice Address - Fax:865-392-3972
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN21771363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ024688Medicaid
TNQ024688Medicaid