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General NPI Number Information
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NPI Number | 1063260172
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Entity Type | Individual
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Provider Name | JENNIFER DARLENE SMITH PMHNP
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Gender | Female
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Dates
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Enumeration Date | 05/13/2024
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 1814 ST JOHN RD
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City | BRAXTON
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State | MS
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Zip | 39044-9470
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Country | US
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Telephone | 601-906-3857
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Fax | 601-951-8236
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Provider Business Mailing Address
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Address Line | 1814 ST JOHN RD
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City | BRAXTON
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State | MS
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Zip | 39044-9470
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Country | US
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Telephone | 601-906-3857
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Fax | 601-951-8236
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 875311
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 906848
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License Number State | MS
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