Doctor Name: | MRS. TRACY J SMILEY |
NPI Number: | 1669571055 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CFNP |
License Number: | R860155 |
Business Practice Address: | 5129 Highway 15 N Ecru, MS - 388419407 |
Business Phone Number: | 6624888799 |
Business Fax Number: | 6624888729 |
Mailing Address: | 1001 County Road 361, NEW ALBANY |
State: | MS |
Postal Code: | 386528851 |
Phone Number: | 6012138264 |
Fax Number: | |
NPI Enumeration Date: | 09/21/2006 |
NPI Last Update Date: | 10/28/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R860155 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |