Healthcare Provider Details

I. General information

NPI: 1013712884
Provider Name (Legal Business Name): SARAH ALYSSA SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH ALYSSA BRAND FNP-C

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 HARDY ST
HATTIESBURG MS
39402-1308
US

IV. Provider business mailing address

87 DICKENS LN
SUMRALL MS
39482-3701
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-8000
  • Fax:
Mailing address:
  • Phone: 601-329-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number907221
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: