Healthcare Provider Details

I. General information

NPI: 1164504106
Provider Name (Legal Business Name): PATRICIA EMILY SMYTH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 COLLEGE ST # MUW-330
COLUMBUS MS
39701-5800
US

IV. Provider business mailing address

1100 COLLEGE ST MUW-330
COLUMBUS MS
39701-5800
US

V. Phone/Fax

Practice location:
  • Phone: 662-329-7289
  • Fax: 662-241-7486
Mailing address:
  • Phone: 662-329-7289
  • Fax: 662-241-7486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR82338662
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: