Provider Demographics
NPI:1629877485
Name:SMITH, CHRISTINA DANYALE (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DANYALE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:DANYALE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1928 PROBY RD SE
Mailing Address - Street 2:
Mailing Address - City:MC CALL CREEK
Mailing Address - State:MS
Mailing Address - Zip Code:39647-5395
Mailing Address - Country:US
Mailing Address - Phone:601-748-5996
Mailing Address - Fax:
Practice Address - Street 1:122 HOLLY STREET
Practice Address - Street 2:
Practice Address - City:BUDE
Practice Address - State:MS
Practice Address - Zip Code:39630
Practice Address - Country:US
Practice Address - Phone:601-600-0442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP322216164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse