Basic Information
| Provider Information | |||||||||
| NPI: | 1639538366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | MELISSA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, APN, FNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WOODWARD | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | MELISSA | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | BSN, RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 20TH AVE N STE 403 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152221400 | ||||||||
| FaxNumber: | 6152221410 | ||||||||
| Practice Location | |||||||||
| Address1: | 4928 EDMONDSON PIKE STE 205 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372114791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152221400 | ||||||||
| FaxNumber: | 6152221410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2016 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 20291 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 103I504356 | 01 | TN | MEDICARE | OTHER | 5542747 | 01 | TN | BCBS OF TN | OTHER | Q025038 | 05 | TN | MEDICAID |