Individual
PETRINA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
919 WILLOW GRANDE CIR, BRANDON, MS 39047-8315
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
907075
MS
Other
Enumeration date
12/02/2025
Last updated
12/02/2025
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