=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902139322
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIDGET M SMITH FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2009
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9221 COOK RD
-----------------------------------------------------
City | BAILEY
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39320-9516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-616-5608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4555 HIGHLAND PARK DR
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39307-5429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-616-5608
-----------------------------------------------------
Fax | 601-581-7676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | MS2126767
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2009003248
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------