Provider Demographics
NPI:1669571055
Name:SMITHEY, TRACY SMILEY (CFNP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:SMILEY
Last Name:SMITHEY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-4113
Mailing Address - Country:US
Mailing Address - Phone:662-236-2232
Mailing Address - Fax:662-236-2264
Practice Address - Street 1:1929 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4113
Practice Address - Country:US
Practice Address - Phone:662-236-2232
Practice Address - Fax:662-236-2264
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS860155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06404041Medicaid