Individual
MRS. SHANA BELLE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
401 S CHURCH ST, CHARLESTON, MS 38921-2257
(662) 647-5816
(662) 647-5705
Mailing address
401 S CHURCH ST, CHARLESTON, MS 38921-2257
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R877613
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R877613
STATE LICENSE
MS
Enumeration date
02/11/2015
Last updated
06/03/2015
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