Provider Demographics
NPI:1568298602
Name:SMITH, DAKOTA TAYLOR (MSN, APRN, ACNPC-AG)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:TAYLOR
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSN, APRN, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 N HAWTHORNE ST # A
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-3103
Mailing Address - Country:US
Mailing Address - Phone:731-307-0307
Mailing Address - Fax:
Practice Address - Street 1:1096 N HAWTHORNE ST # A
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-3103
Practice Address - Country:US
Practice Address - Phone:731-307-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37053363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine