Provider Demographics
NPI:1235544339
Name:CAMPBELL-SMITH, RAVEN M (FNP-C)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:M
Last Name:CAMPBELL-SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100B LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-2046
Mailing Address - Country:US
Mailing Address - Phone:225-288-7081
Mailing Address - Fax:
Practice Address - Street 1:300 HIGHLAND BLVD STE B
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4600
Practice Address - Country:US
Practice Address - Phone:601-304-2421
Practice Address - Fax:601-446-6428
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS890984363LP2300X
LAAP07860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily