Healthcare Provider Details

I. General information

NPI: 1902139322
Provider Name (Legal Business Name): BRIDGET M SMITH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 COOK RD
BAILEY MS
39320-9516
US

IV. Provider business mailing address

4555 HIGHLAND PARK DR
MERIDIAN MS
39307-5429
US

V. Phone/Fax

Practice location:
  • Phone: 601-616-5608
  • Fax:
Mailing address:
  • Phone: 601-616-5608
  • Fax: 601-581-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberMS2126767
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2009003248
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: