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General NPI Number Information
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NPI Number | 1861957508
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Entity Type | Individual
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Provider Name | MARILYN SMITH NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 228 STARLYN AVE
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City | NEW ALBANY
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State | MS
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Zip | 38652-2428
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Country | US
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Telephone | 662-539-7383
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Fax | 662-539-7661
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Provider Business Mailing Address
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Address Line | 100 COUNTY ROAD 405
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City | OXFORD
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State | MS
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Zip | 38655-9205
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Country | US
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Telephone | 662-607-1460
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 902598
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License Number State | MS
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