Healthcare Provider Details

I. General information

NPI: 1093287773
Provider Name (Legal Business Name): KATHYRN SMITH HILBERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHYRN MONIQUE SMITH

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4381 S EASON BLVD STE 201
TUPELO MS
38801-6585
US

IV. Provider business mailing address

808 VARSITY DR
TUPELO MS
38801-4613
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-5199
  • Fax:
Mailing address:
  • Phone: 662-377-2386
  • Fax: 662-377-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number902909
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: