Individual
LISA A MCKINNEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
105 W STONE DR STE 1J, KINGSPORT, TN 37660-3365
(423) 378-7654
(423) 578-8025
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2093
(423) 390-3340
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
0102201581
VA
207RP1001X
Pulmonary Disease Physician
Primary
DO1464
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005651B56
TRAILBLAZERS MEDICARE
VA
05
—
3300707
—
TN
01
—
P00149425
PALMETTO RR MEDICARE
TN
01
—
P00149425
PALMETTO RR MEDICARE
VA
Enumeration date
08/26/2005
Last updated
12/17/2021
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