Provider Demographics
NPI:1073505418
Name:SMITH, JENE' WHITE (APN)
Entity Type:Individual
Prefix:
First Name:JENE'
Middle Name:WHITE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 BELK BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5301
Mailing Address - Country:US
Mailing Address - Phone:662-236-4675
Mailing Address - Fax:662-281-0819
Practice Address - Street 1:1397 BELK BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5301
Practice Address - Country:US
Practice Address - Phone:662-236-4675
Practice Address - Fax:662-281-0819
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN10914363LA2100X
MSR864717363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09058711Medicaid
MS302I509046Medicare PIN
Q37343Medicare UPIN