Provider Demographics
NPI:1932932837
Name:SMITH, AMY VICTORIA OAKS (BSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:VICTORIA OAKS
Last Name:SMITH
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 MOSS TRL
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2002
Mailing Address - Country:US
Mailing Address - Phone:615-968-3782
Mailing Address - Fax:
Practice Address - Street 1:412 MOSS TRL
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2002
Practice Address - Country:US
Practice Address - Phone:615-968-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL-101567163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant