Provider Demographics
NPI:1740790658
Name:SMITH, ARLETTE (NP)
Entity Type:Individual
Prefix:
First Name:ARLETTE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4001
Mailing Address - Country:US
Mailing Address - Phone:601-508-3382
Mailing Address - Fax:
Practice Address - Street 1:1102 CONSTITUTION AVE FL 5
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4001
Practice Address - Country:US
Practice Address - Phone:601-703-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902179363LF0000X
MSF07230054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily