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General NPI Number Information
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NPI Number | 1891519286
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Entity Type | Individual
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Provider Name | YALINDA SMITH ROACH FNP
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Gender | Female
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 103 BASKET ST
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City | ITTA BENA
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State | MS
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Zip | 38941-2801
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Country | US
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Telephone | 662-254-7801
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Fax | 662-254-9173
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Provider Business Mailing Address
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Address Line | 521 RED BIRD DR
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City | GREENWOOD
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State | MS
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Zip | 38930-7319
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Country | US
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Telephone |
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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 | 907070
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License Number State | MS
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