Individual
MARY T SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
215 KATHERINE DR STE A, FLOWOOD, MS 39232-9588
(601) 665-4162
(888) 398-1151
Mailing address
PO BOX 4128, MERIDIAN, MS 39304-4128
(601) 581-7600
(601) 483-5543
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
668699
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000119998
—
MS
Enumeration date
12/14/2006
Last updated
10/18/2023
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