Provider Demographics
NPI:1053606350
Name:SMITH, BRITTANY LENICE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:LENICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:LENICE
Other - Last Name:BRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:3630 BAILEY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-0002
Mailing Address - Country:US
Mailing Address - Phone:773-704-5180
Mailing Address - Fax:
Practice Address - Street 1:3295 POPLAR AVE STE 105
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4690
Practice Address - Country:US
Practice Address - Phone:901-725-9055
Practice Address - Fax:866-493-2966
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10350I9199Medicare PIN
TNP00944302Medicare PIN