Provider Demographics
NPI:1568907392
Name:SMITH, SUSAN DARLENE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DARLENE
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 1:101 RICKY D BRITT SR BLVD
Mailing Address - Street 2:SUITE 1 AND 2
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-9103
Mailing Address - Country:US
Mailing Address - Phone:662-236-5442
Mailing Address - Fax:662-236-5295
Practice Address - Street 1:101 RICKY D BRITT SR BLVD
Practice Address - Street 2:SUITE 1 AND 2
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9103
Practice Address - Country:US
Practice Address - Phone:662-236-5442
Practice Address - Fax:662-236-5295
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily