Provider Demographics
NPI:1992384945
Name:SMITH, YOLONDA COLEMAN (AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:YOLONDA
Middle Name:COLEMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:YOLONDA
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:103 STONEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-9684
Mailing Address - Country:US
Mailing Address - Phone:601-910-1264
Mailing Address - Fax:
Practice Address - Street 1:6508 DOGWOOD VIEW PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7868
Practice Address - Country:US
Practice Address - Phone:301-532-7685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904204363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty