Provider Demographics
NPI:1871160143
Name:SMITH, MICHAEL P (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:350 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2177
Mailing Address - Country:US
Mailing Address - Phone:901-226-4003
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:1225 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2064
Practice Address - Country:US
Practice Address - Phone:901-226-4003
Practice Address - Fax:901-227-8591
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0037024363L00000X
FL11012101363LF0000X
MS907809363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily