Provider Demographics
NPI:1942256300
Name:SMITH, MELISSA F (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:F
Last Name:SMITH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-450-0231
Practice Address - Street 1:66 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8382
Practice Address - Country:US
Practice Address - Phone:601-544-7500
Practice Address - Fax:601-544-7524
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS803904363LP0808X
MSR803904363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02070024Medicaid
MSP00323873OtherRR MCARE W PARADIGM
MSP00323873OtherRR MCARE W PARADIGM
MS500001896Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MS500002135Medicare ID - Type UnspecifiedPROVIDER # W PARADIGM