Provider Demographics
NPI:1225875792
Name:SMITH, KORI LYNN (PA-S)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-2007
Mailing Address - Country:US
Mailing Address - Phone:423-444-1912
Mailing Address - Fax:
Practice Address - Street 1:5220 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-2007
Practice Address - Country:US
Practice Address - Phone:423-444-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program