Healthcare Provider Details

I. General information

NPI: 1942256300
Provider Name (Legal Business Name): MELISSA F SMITH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 OLD AIRPORT RD
HATTIESBURG MS
39401-8382
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-544-7500
  • Fax: 601-544-7524
Mailing address:
  • Phone: 601-545-8700
  • Fax: 601-450-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number803904
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR803904
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: