Provider Demographics
NPI:1427310861
Name:SMITH, ELISABETH BENNETT (PA)
Entity type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:BENNETT
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:RHACHAEL
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4306 HARDING RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205
Mailing Address - Country:US
Mailing Address - Phone:814-977-2555
Mailing Address - Fax:615-383-6646
Practice Address - Street 1:4306 HARDING RD
Practice Address - Street 2:SUITE 106
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-3593
Practice Address - Country:US
Practice Address - Phone:615-297-5798
Practice Address - Fax:615-383-6646
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNEG46411Medicare UPIN
TN103G703418Medicare PIN