Provider Demographics
NPI:1225323090
Name:SMITH, LORA MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:MICHELLE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2778 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-9403
Mailing Address - Country:US
Mailing Address - Phone:662-560-5966
Mailing Address - Fax:662-560-5969
Practice Address - Street 1:2416 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2001
Practice Address - Country:US
Practice Address - Phone:662-298-3181
Practice Address - Fax:662-269-4704
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15770363LF0000X
MSR88-2467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily