Individual
GRACE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
208 KEY DR STE C, MADISON, MS 39110-7378
(601) 760-2050
Mailing address
208 KEY DR, MADISON, MS 39110-7378
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
905572
MS
Other
Enumeration date
10/27/2022
Last updated
10/27/2022
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