Healthcare Provider Details

I. General information

NPI: 1356380067
Provider Name (Legal Business Name): JOYCE L SMITH F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15921 BOUNDARY DR
ASHLAND MS
38603-7740
US

IV. Provider business mailing address

263 COTTON GIN RD
RIPLEY MS
38663-9044
US

V. Phone/Fax

Practice location:
  • Phone: 662-223-4011
  • Fax: 662-223-4018
Mailing address:
  • Phone: 662-837-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR545953
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: