Provider Demographics
NPI:1043923626
Name:SMITH, SHERREN (RN-BSN NURSE)
Entity Type:Individual
Prefix:
First Name:SHERREN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN-BSN NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-5111
Mailing Address - Country:US
Mailing Address - Phone:601-479-3792
Mailing Address - Fax:
Practice Address - Street 1:3701 8TH ST STE C
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-6083
Practice Address - Country:US
Practice Address - Phone:601-479-3792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS880683163WC1400X, 163WC1500X, 163WD0400X, 163WG0000X, 163WP0807X, 163WP0808X, 163WW0000X, 163WX0106X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health