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General NPI Number Information
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NPI Number | 1861591067
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Entity Type | Individual
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Provider Name | CAROL LEE SMITH MSN CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1500 WOODROW WILSON
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City | JACKSON
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State | MS
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Zip | 39216-5199
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Country | US
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Telephone | 800-949-1009
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Fax |
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Provider Business Mailing Address
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Address Line | 153 VINEYARD BLVD
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City | BRANDON
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State | MS
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Zip | 39047
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Country | US
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Telephone | 601-291-9882
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-021304
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License Number State | AL
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