Active NPI
Tina Kayzellers Smith, NP
- Family Nurse Practitioner
- Cordova, TN
National Provider Identifier
1629565536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 23820
- Practice address
- 146 Timber Creek Dr Ste 200
Cordova, TN 38018 - Phone
- (901) 751-4112
- Fax
- (901) 751-9878
- NPI assigned
- Apr 16, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 23820 | TN | Primary |
Addresses
Primary practice location
146 Timber Creek Dr Ste 200
Cordova, TN 38018
Mailing address
2606 Meadow Run
Germantown, TN 38138-6254
Phone (901) 361-5886
Other practice location 1
650 Joel Dr
Fort Campbell, KY 42223-5318
Phone (270) 798-8095
Other practice location 2
2016 Greystone Sq
Jackson, TN 38305-3575
Phone (731) 664-1773
Other practice location 3
146 Timber Creek Dr Ste 200
Cordova, TN 38018
Phone (901) 751-4112
Other practice location 4
122 Airways Pl
Southaven, MS 38671-5872
Phone (662) 349-9990
Other practice location 5
2908 S LaMar Blvd Ste 300
Oxford, MS 38655-5375
Phone (662) 236-5442
Other practice location 6
609 Brunson Dr
Tupelo, MS 38801-4948
Phone (662) 891-8662
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 220366 | Other | TN | RN |
| 23820 | Other | TN | APN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23820 | TN | MD | Family Nurse Practitioner |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/IFDHCD/Endpoint/IFDHCD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539129600000",
"number": "1629565536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2606 MEADOW RUN",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381386254",
"telephone_number": "901-361-5886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 TIMBER CREEK DR STE 200",
"city": "CORDOVA",
"state": "TN",
"postal_code": "38018",
"telephone_number": "901-751-4112",
"fax_number": "901-751-9878"
}
],
"practiceLocations": [
{
"address_1": "650 Joel Dr",
"address_purpose": "LOCATION",
"city": "Fort Campbell",
"state": "KY",
"postal_code": "422235318",
"country_code": "US",
"telephone_number": "270-798-8095",
"fax_number": "919-655-1343",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2016 Greystone Sq",
"address_purpose": "LOCATION",
"city": "Jackson",
"state": "TN",
"postal_code": "383053575",
"country_code": "US",
"telephone_number": "731-664-1773",
"fax_number": "731-664-1751",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "146 Timber Creek Dr Ste 200",
"address_purpose": "LOCATION",
"city": "Cordova",
"state": "TN",
"postal_code": "38018",
"country_code": "US",
"telephone_number": "901-751-4112",
"fax_number": "901-751-9878",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "122 Airways Pl",
"address_purpose": "LOCATION",
"city": "Southaven",
"state": "MS",
"postal_code": "386715872",
"country_code": "US",
"telephone_number": "662-349-9990",
"fax_number": "662-349-2620",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2908 S LaMar Blvd Ste 300",
"address_purpose": "LOCATION",
"city": "Oxford",
"state": "MS",
"postal_code": "386555375",
"country_code": "US",
"telephone_number": "662-236-5442",
"fax_number": "662-236-5295",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "609 Brunson Dr",
"address_purpose": "LOCATION",
"city": "Tupelo",
"state": "MS",
"postal_code": "388014948",
"country_code": "US",
"telephone_number": "662-891-8662",
"fax_number": "662-269-1775",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SMITH",
"first_name": "TINA",
"middle_name": "KAYZELLERS",
"name_prefix": "Mrs.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-16",
"last_updated": "2018-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TN",
"license": "23820",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN",
"identifier": "220366",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "APN",
"identifier": "23820",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cordova, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; 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.