Individual
BRANDON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1017 JACKSON AVE, LEAKESVILLE, MS 39451-9105
(601) 394-2820
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 947-1330
(601) 947-1331
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
901721
MS
363LF0000X
Family Nurse Practitioner
NP95002747
CA
363LF0000X
Family Nurse Practitioner
NUR-APRN-LIC-194292
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
901721
MSBON LICENSURE
MS
Enumeration date
07/23/2015
Last updated
04/28/2025
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