Individual provider Active NPI

Kylie Brown Smith, APN

  • Family Nurse Practitioner
  • Alamo, TN
National Provider Identifier
1124342605
Registry record updated Apr 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
14845 Issued in TN
Practice address
58 S Bells St
Alamo, TN 38001-1700
Phone
(731) 696-5401
NPI assigned
Mar 26, 2010
Last updated
Apr 29, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 14845 TN Primary

Addresses

Primary practice location

58 S Bells St
Alamo, TN 38001-1700

Mailing address

58 S Bells St
Alamo, TN 38001-1700
Phone (731) 696-5401

Other identifiers 1

IdentifierTypeStateIssuer
1527174MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120224000717 TN Practitioner - Nurse Practitioner 9335307149 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
14845TNMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Oct 3, 2022 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Oct 3, 2022 Accepting new patients

Locations

2634 N Central Ave
Humboldt, TN 38343
Phone (731) 324-1526

108 Courtright Rd
Martin, TN 38237
Phone (731) 281-4183

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1269561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1124342605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 S BELLS ST",
            "city": "ALAMO",
            "state": "TN",
            "postal_code": "380011700",
            "telephone_number": "731-696-5401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 S BELLS ST",
            "city": "ALAMO",
            "state": "TN",
            "postal_code": "380011700",
            "telephone_number": "731-696-5401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KYLIE",
        "middle_name": "BROWN",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-26",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "14845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1527174",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alamo, TN

Sources for this page

Verify at the official NPI Registry.