Healthcare Provider Details

I. General information

NPI: 1629877485
Provider Name (Legal Business Name): CHRISTINA DANYALE SMITH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA DANYALE MITCHELL LPN

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 HOLLY STREET
BUDE MS
39630
US

IV. Provider business mailing address

1928 PROBY RD SE
MC CALL CREEK MS
39647-5395
US

V. Phone/Fax

Practice location:
  • Phone: 601-600-0442
  • Fax:
Mailing address:
  • Phone: 601-748-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP322216
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: