MEDICARE: ANGELA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	930761	MS

General Provider Information

NPI Number	:	1538017702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SMITH

Provider Business Mailing Address
First Line	:	PO BOX 101
Second Line	:
City	:	WALLS
State	:	MS
Zip	:	38680-0101
Country	:	US
Telephone Number	:	901-364-8610
Fax Number	:

Provider Business Practice Location Address
First Line	:	3132 CAMILLA CIR E
Second Line	:
City	:	LAKE CORMORANT
State	:	MS
Zip	:	38641-1007
Country	:	US
Telephone Number	:	901-364-8610
Fax Number	:	901-364-8610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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Directions to “ ANGELA SMITH ” Practice Location

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