Individual
ERICA KELLYN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
(601) 883-5000
Mailing address
4 GLENWOOD CIR, VICKSBURG, MS 39180-3942
(601) 540-4936
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
PA00777
MS
363A00000X
Physician Assistant
Primary
PA00777
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
03/25/2019
Last updated
02/20/2024
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