Coleen Marie Smith, D.O.

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

1434 Issued in TN

Practice address

111 W 10TH Ave
Johnson City, TN 37604-3844

Phone

(423) 722-9355

Fax

(423) 722-9333

NPI assigned

Oct 6, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2013 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1164519880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W 10TH AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376043844",
            "telephone_number": "423-722-9355",
            "fax_number": "423-722-9333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W 10TH AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376043844",
            "telephone_number": "423-722-9355",
            "fax_number": "423-722-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "COLEEN",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "TN",
            "license": "1434",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "1434",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/ BLUE SHIELD",
            "identifier": "4043727",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candice Ashley Smith, B.A.
• Chandar Smith
• Christian Zach Smith, CPO
• Christina V Smith, LPC-MHSP
• Christy J Smith, APN
• Elijah Smith
• Elizabeth A Smith, NP
• Elizabeth C. Smith, M.D.
• Felicia Desiree Smith, FNP
• Jerrica Smith

• Neuromusculoskeletal Medicine & OMM Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.