Individual
MR. KEVIN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1900 EXETER RD, GERMANTOWN, TN 38138
(901) 818-2160
Mailing address
6910 7TH RD, BARTLETT, TN 38135-2568
(901) 386-8539
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN0000158867
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
APN 16753
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09552701
—
MS
05
—
1528772
—
TN
05
—
192893001
—
AR
01
—
1992062020
CHAMPUS/TRICARE
TN
01
—
4327295
BCBST
TN
Enumeration date
04/13/2012
Last updated
04/10/2013
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