Provider Demographics
NPI:1053428516
Name:SMITH, LYNDA M (MSN, FNP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-0793
Mailing Address - Country:US
Mailing Address - Phone:423-238-0033
Mailing Address - Fax:
Practice Address - Street 1:5121 OOLTEWAH-RINGGOLD ROAD
Practice Address - Street 2:SUITE G
Practice Address - City:COLLEGEDALE
Practice Address - State:TN
Practice Address - Zip Code:37315
Practice Address - Country:US
Practice Address - Phone:423-238-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily