Healthcare Provider Details

I. General information

NPI: 1013712884
Provider Name (Legal Business Name): SARAH ALYSSA SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH ALYSSA BRAND FNP-C

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4891 HIGHWAY 589
SUMRALL MS
39482-4453
US

IV. Provider business mailing address

4891 HIGHWAY 589
SUMRALL MS
39482-4453
US

V. Phone/Fax

Practice location:
  • Phone: 601-516-9024
  • Fax: 601-516-9025
Mailing address:
  • Phone: 601-329-4801
  • Fax: 601-516-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number907221
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: