Healthcare Provider Details

I. General information

NPI: 1043923626
Provider Name (Legal Business Name): SHERREN SMITH RN-BSN NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 8TH ST STE C
MERIDIAN MS
39307-6083
US

IV. Provider business mailing address

2504 45TH AVE
MERIDIAN MS
39307-5111
US

V. Phone/Fax

Practice location:
  • Phone: 601-479-3792
  • Fax:
Mailing address:
  • Phone: 601-479-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number880683
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number880683
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number880683
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number880683
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number880683
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number880683
License Number StateMS
# 7
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number880683
License Number StateMS
# 8
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number880683
License Number StateMS
# 9
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number880683
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: