Healthcare Provider Details

I. General information

NPI: 1275450157
Provider Name (Legal Business Name): GABRIELLE SMITH HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GOODMAN RD E
SOUTHAVEN MS
38671-9525
US

IV. Provider business mailing address

465 GOODMAN RD E
SOUTHAVEN MS
38671-9525
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-8899
  • Fax:
Mailing address:
  • Phone: 666-234-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA-709
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: