Provider Demographics
NPI:1366513772
Name:SMITH, JAMES M (MSN-CRNA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:18797 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-2127
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11282367500000X
TNRN106433367500000X
KY4873A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505098Medicaid
KY74002684Medicaid
KY000000522382OtherBLUE CROSS/BLUE SHIELD
TN4096038OtherBC INDIVIDUAL NUMBER
TN4175840OtherBLUE CROSS/BLUE SHIELD
TN4096038OtherBC INDIVIDUAL NUMBER
KY000000522382OtherBLUE CROSS/BLUE SHIELD
TN36311801Medicare PIN