Doctor Name: | MRS. STEPHANIE D. SMITH |
NPI Number: | 1003055005 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CFNP |
License Number: | R865285 |
Business Practice Address: | 1101 Hwy 11 S Ellisville, MS - 394374443 |
Business Phone Number: | 6014775770 |
Business Fax Number: | |
Mailing Address: | 57 Watertank Rd, LAUREL |
State: | MS |
Postal Code: | 394432954 |
Phone Number: | 6015771000 |
Fax Number: | |
NPI Enumeration Date: | 02/13/2009 |
NPI Last Update Date: | 02/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R865285 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |