Healthcare Provider Details

I. General information

NPI: 1568377349
Provider Name (Legal Business Name): OLIVIA CARPENTER SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JK AVENT DR
GRENADA MS
38901
US

IV. Provider business mailing address

2704 W OXFORD LOOP STE 117
OXFORD MS
38655-5728
US

V. Phone/Fax

Practice location:
  • Phone: 662-227-7000
  • Fax:
Mailing address:
  • Phone: 662-550-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: