Healthcare Provider Details

I. General information

NPI: 1912832148
Provider Name (Legal Business Name): ANGELA N SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 STEGALL RD
WESSON MS
39191-7299
US

IV. Provider business mailing address

3065 STEGALL RD
WESSON MS
39191-7299
US

V. Phone/Fax

Practice location:
  • Phone: 601-320-1105
  • Fax:
Mailing address:
  • Phone: 601-320-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number876305
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: