Individual
JOHN D SMITH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
15190 COMMUNITY RD STE 120, GULFPORT, MS 39503-3484
(228) 205-6825
(228) 831-8782
Mailing address
15190 COMMUNITY RD STE 120, GULFPORT, MS 39503-3484
(228) 205-6825
(228) 831-8782
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R871827
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003101732
—
MS
01
—
5707330001
NSC
MS
Enumeration date
09/08/2006
Last updated
01/25/2024
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