Provider Demographics
NPI:1285307900
Name:SMITH, STEPHANIE K (FNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 SAGEGRASS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-3564
Mailing Address - Country:US
Mailing Address - Phone:865-292-5953
Mailing Address - Fax:
Practice Address - Street 1:1787 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6945
Practice Address - Country:US
Practice Address - Phone:865-255-7543
Practice Address - Fax:865-428-4767
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30013363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ069651Medicaid