Jacqueline Rena Smith, APRN, BC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

6069 Issued in TN

Practice address

1224 Trotwood Ave
Columbia, TN 38401-4802

Phone

(931) 381-1111

Fax

(931) 540-4294

NPI assigned

Jan 23, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Maury Regional Medical Group, Inc

  • Family Medicine Physician
  • Columbia, TN
  • NPI 1205886264

  Acute Care

  Medicare reassignment NPD
• Maury Regional Hospital Marshall Medical Center

  • Rural Health Clinic/Center
  • Spring Hill, TN
  • NPI 1548889850
  NPD
• Maury Regional Hospital Marshall Medical Center

  • Rural Health Clinic/Center
  • Columbia, TN
  • NPI 1700406881
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326192519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 TROTWOOD AVE",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384014802",
            "telephone_number": "931-381-1111",
            "fax_number": "931-540-4294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 TROTWOOD AVE",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384014802",
            "telephone_number": "931-381-1111",
            "fax_number": "931-540-4294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACQUELINE",
        "middle_name": "RENA",
        "name_prefix": "Ms.",
        "credential": "APRN, BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TN",
            "license": "6069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN - APN LICENSE",
            "identifier": "6069",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN - RN LICENSE",
            "identifier": "70910",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Devonna Rachelle Smith
• Gregory Allen Smith
• Hailey Smith, PT
• Hannah Kai Smith
• Hudson Smith
• Jaime Smith
• Lang Smith
• Lauren Smith, RN
• Linda R Smith, OFFICIAL AGENT
• Marvin Montgomery Smith, M.D.

• Acute Care Nurse Practitioner in Columbia, TN
• Providers in Columbia, TN by specialty
• Acute Care Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.