Healthcare Provider Details

I. General information

NPI: 1710472758
Provider Name (Legal Business Name): RAGEN LAYNE SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PEARL ST # B
CARTHAGE MS
39051-4108
US

IV. Provider business mailing address

PO BOX 23996
JACKSON MS
39225-3996
US

V. Phone/Fax

Practice location:
  • Phone: 601-298-0333
  • Fax: 601-298-0797
Mailing address:
  • Phone: 601-206-6100
  • Fax: 601-206-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902627
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: