Provider Demographics
NPI:1689359382
Name:JONES-SMITH, PHYLLISIA ANDRELLE (MHS)
Entity Type:Individual
Prefix:
First Name:PHYLLISIA
Middle Name:ANDRELLE
Last Name:JONES-SMITH
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406C WEST ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-3843
Mailing Address - Country:US
Mailing Address - Phone:318-435-7715
Mailing Address - Fax:
Practice Address - Street 1:2406C WEST ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3843
Practice Address - Country:US
Practice Address - Phone:318-435-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator