Provider Demographics
NPI:1174740047
Name:SMITH, RONALD RAY (APRN)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:RAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2343
Mailing Address - Country:US
Mailing Address - Phone:615-594-9144
Mailing Address - Fax:931-962-5162
Practice Address - Street 1:520 WARREN CHAPEL RD
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324-3937
Practice Address - Country:US
Practice Address - Phone:931-962-5060
Practice Address - Fax:931-962-5162
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12132363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care