Provider Demographics
NPI:1316117013
Name:SMITH, CHRISTY J (APN)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2617
Mailing Address - Country:US
Mailing Address - Phone:423-224-3950
Mailing Address - Fax:423-224-3959
Practice Address - Street 1:378 MARKETPLACE DR STE 5
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2361
Practice Address - Country:US
Practice Address - Phone:423-282-0751
Practice Address - Fax:423-282-1577
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316117013Medicaid
TN3341759Medicaid
TN3709285Medicare UPIN
VA1316117013Medicaid
TN103I507700Medicare PIN
VAC09112Medicare UPIN
TN103I507700Medicare PIN