Provider Demographics
NPI:1568814655
Name:SMITH, SHERRICA SHERRELL (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHERRICA
Middle Name:SHERRELL
Last Name: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 1:785 OHIO AVE
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6217
Mailing Address - Country:US
Mailing Address - Phone:662-624-5801
Mailing Address - Fax:662-624-5804
Practice Address - Street 1:785 OHIO AVE
Practice Address - Street 2:SUITE 3E
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6217
Practice Address - Country:US
Practice Address - Phone:662-624-5801
Practice Address - Fax:662-624-5804
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily