Provider Demographics
NPI:1124611173
Name:SMITH, AMY S (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 ELA RD
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-8241
Mailing Address - Country:US
Mailing Address - Phone:828-488-0939
Mailing Address - Fax:828-488-6635
Practice Address - Street 1:4747 ELA RD
Practice Address - Street 2:
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-8241
Practice Address - Country:US
Practice Address - Phone:828-488-0939
Practice Address - Fax:828-488-6635
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227418163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool