Individual
KELLY M SMART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A
Contact information
Practice address
141 HILLCREST DR, CLARKSVILLE, TN 37043
(931) 552-4340
(931) 552-0999
Mailing address
608 NORRIS AVE, NASHVILLE, TN 37204
(615) 695-1407
(615) 695-1483
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1125
TN
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3663312
—
TN
05
—
620862316
—
TN
01
—
9500536900
KENTUCKY MEDICAID
KY
Enumeration date
05/24/2005
Last updated
10/31/2019
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