Healthcare Provider Details

I. General information

NPI: 1366596066
Provider Name (Legal Business Name): REGINA CHRISTY SMITH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINA CHRISTINE DODD APN

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3964 GOODMAN RD E STE 131
SOUTHAVEN MS
38672-8762
US

IV. Provider business mailing address

3964 GOODMAN RD E STE 131
SOUTHAVEN MS
38672-8762
US

V. Phone/Fax

Practice location:
  • Phone: 662-856-8440
  • Fax: 662-350-7032
Mailing address:
  • Phone: 662-856-8440
  • Fax: 662-350-7032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number908491
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number11744
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: