Healthcare Provider Details

I. General information

NPI: 1023643715
Provider Name (Legal Business Name): VANESSA LOUISE MCBRIDE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA LOUISE SMITH NP-C

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 GALAXIE DR
JACKSON MS
39206-4308
US

IV. Provider business mailing address

214 BARRINGTON DR
BYRAM MS
39272-9239
US

V. Phone/Fax

Practice location:
  • Phone: 601-713-0890
  • Fax: 601-366-3415
Mailing address:
  • Phone: 601-832-0974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903727
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: