Provider Demographics
NPI:1013712884
Name:SMITH, SARAH ALYSSA (FNP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ALYSSA
Last Name:SMITH
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ALYSSA
Other - Last Name:BRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:87 DICKENS LN
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482-3701
Mailing Address - Country:US
Mailing Address - Phone:601-329-4801
Mailing Address - Fax:
Practice Address - Street 1:5001 HARDY ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1308
Practice Address - Country:US
Practice Address - Phone:601-268-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907221363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty