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Individual

TYESHA SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ALL

Contact information

Practice address
200 REBEL WOODS DR, JACKSON, MS 39212-3009
(601) 317-4606
Mailing address
200 REBEL WOODS DR APT A8, JACKSON, MS 39212-3003
(601) 317-4606

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
MS
374U00000X
Home Health Aide
Primary
MS

Other

Enumeration date
02/11/2020
Last updated
07/05/2020
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