Jaclyn Brooke Smith, RN, CCM

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

License

0000188383 Issued in TN

Practice address

374 Windy Hollow LN
Soddy Daisy, TN 37379-2858

Phone

(423) 243-8970

Fax

(877) 211-6848

NPI assigned

Nov 20, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1063287050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 WINDY HOLLOW LN",
            "city": "SODDY DAISY",
            "state": "TN",
            "postal_code": "373792858",
            "telephone_number": "423-243-8970",
            "fax_number": "877-211-6848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 WINDY HOLLOW LN",
            "city": "SODDY DAISY",
            "state": "TN",
            "postal_code": "373792858",
            "telephone_number": "423-243-8970",
            "fax_number": "877-211-6848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACLYN",
        "middle_name": "BROOKE",
        "name_prefix": "Mrs.",
        "credential": "RN, CCM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-20",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "TN",
            "license": "0000188383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert V Shearer, DDS
• Ashlie Brooke Sides
• Latisha Monique Simmons, DSW
• Deidra Gayle Smith, RN
• Elizabeth Culbreath Smith, MSN, NP-C
• Juliana Sneed
• Soddy Daisy Family Care
• Soddy Daisy Healthcare, LLC (Soddy-Daisy Health Care Center)
• Soddy Daisy Medical Care
• Soddy Daisy Pediatrics

• Case Management Registered Nurse in Soddy Daisy, TN
• Providers in Soddy Daisy, TN by specialty
• Case Management Registered Nurse in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.