Provider Demographics
NPI:1023653037
Name:SMITH, STACI (FNP)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:HOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:199 MORRIS LN
Mailing Address - Street 2:
Mailing Address - City:WARTRACE
Mailing Address - State:TN
Mailing Address - Zip Code:37183-3112
Mailing Address - Country:US
Mailing Address - Phone:931-703-0829
Mailing Address - Fax:
Practice Address - Street 1:2012 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2022
Practice Address - Country:US
Practice Address - Phone:931-703-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26843363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care