Individual
MR. ETHAN TYLER SMITHERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
324 W VALLEY ST STE 108, HERNANDO, MS 38632-1749
(901) 491-0130
Mailing address
324 W VALLEY ST STE 108, HERNANDO, MS 38632-1749
(901) 491-0130
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
905753
MS
Other
Enumeration date
02/01/2023
Last updated
02/01/2023
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