Provider Demographics
NPI:1437380961
Name:TATUM SMITH, SARAH MARGARET (MSN, CFNP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARGARET
Last Name:TATUM SMITH
Suffix:
Gender:F
Credentials:MSN, CFNP
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:MARGARET
Other - Last Name:TATUM SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, CFNP
Mailing Address - Street 1:823 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-3233
Mailing Address - Country:US
Mailing Address - Phone:662-751-8190
Mailing Address - Fax:662-751-8112
Practice Address - Street 1:823 GRAND AVE
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-3233
Practice Address - Country:US
Practice Address - Phone:662-746-2261
Practice Address - Fax:662-746-4839
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS869275363L00000X
MSR869275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner