Provider Demographics
NPI:1558370205
Name:SMITH, JENA NAOMI (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENA
Middle Name:NAOMI
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 DRAPERTON CT
Mailing Address - Street 2:PRICE DERMATOLOGY
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-3905
Mailing Address - Country:US
Mailing Address - Phone:601-992-3996
Mailing Address - Fax:601-414-0221
Practice Address - Street 1:212 DRAPERTON CT
Practice Address - Street 2:PRICE DERMATOLOGY
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3905
Practice Address - Country:US
Practice Address - Phone:601-992-3996
Practice Address - Fax:601-414-0221
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR822693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04827502Medicaid