Provider Demographics
NPI:1891193264
Name:SMITH, ANNA KAYE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:KAYE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 COUNTY ROAD 544
Mailing Address - Street 2:
Mailing Address - City:RIENZI
Mailing Address - State:MS
Mailing Address - Zip Code:38865-9580
Mailing Address - Country:US
Mailing Address - Phone:662-808-0327
Mailing Address - Fax:
Practice Address - Street 1:611 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9321
Practice Address - Country:US
Practice Address - Phone:662-293-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR888533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily