Provider Demographics
NPI:1851876627
Name:SMITH, KRISTI DIANN (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:DIANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:DIANN
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3275 HIGHWAY 371 N
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855-7145
Mailing Address - Country:US
Mailing Address - Phone:662-282-7555
Mailing Address - Fax:
Practice Address - Street 1:3275 HIGHWAY 371 N
Practice Address - Street 2:
Practice Address - City:MANTACHIE
Practice Address - State:MS
Practice Address - Zip Code:38855-7145
Practice Address - Country:US
Practice Address - Phone:662-282-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily