Healthcare Provider Details

I. General information

NPI: 1144098138
Provider Name (Legal Business Name): CHERISH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 LEGACY PARK
RIDGELAND MS
39157-4315
US

IV. Provider business mailing address

116 TARA DR
FLORA MS
39071-9216
US

V. Phone/Fax

Practice location:
  • Phone: 729-233-7154
  • Fax:
Mailing address:
  • Phone: 601-879-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number261010
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: