Healthcare Provider Details

I. General information

NPI: 1225323090
Provider Name (Legal Business Name): LORA MICHELLE SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORA MICHELLE WOOD

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 MOUNT PLEASANT RD
HERNANDO MS
38632-2001
US

IV. Provider business mailing address

2778 HIGHWAY 51 S
SENATOBIA MS
38668-9403
US

V. Phone/Fax

Practice location:
  • Phone: 662-298-3181
  • Fax: 662-269-4704
Mailing address:
  • Phone: 662-560-5966
  • Fax: 662-560-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15770
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR88-2467
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: