Provider Demographics
NPI:1215021001
Name:SMITH, KATHERINE CHAFFIN (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:CHAFFIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 AIRWAYS PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5872
Mailing Address - Country:US
Mailing Address - Phone:662-349-9990
Mailing Address - Fax:662-349-2620
Practice Address - Street 1:101 RICKY D BRITT SR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9103
Practice Address - Country:US
Practice Address - Phone:662-236-5442
Practice Address - Fax:662-236-5295
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858087363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06230207Medicaid
MS06230207Medicaid