MEDICARE: REBEKAH SMITH NP

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	363LF0000X	Family Nurse Practitioner	R858253	MS

General Provider Information

NPI Number	:	1962464883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH SMITH NP

Provider Business Mailing Address
First Line	:	1301 VETERANS MEMORIAL BLVD
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-2064
Country	:	US
Telephone Number	:	662-258-7200
Fax Number	:	662-258-5871

Provider Business Practice Location Address
First Line	:	1301 VETERANS MEMORIAL BLVD
Second Line	:
City	:	EUPORA
State	:	MS
Zip	:	39744-2064
Country	:	US
Telephone Number	:	662-258-7200
Fax Number	:	662-258-5871

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	08/09/2017

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