Smith, John D
Smith, John D is an individual health care provider with primary practice located at 15190 Community Rd Ste 120 , Gulfport MS 39503-3484. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as his primary health care specialty. Smith, John D can be contacted via phone (228) 205-6825.Contact Information
Primary practice address
15190 Community Rd Ste 120
Gulfport MS 39503-3484
Phone: (228) 205-6825
Fax: (228) 831-8782
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | R871827 | Mississippi |
Profile Details
| NPI number | 1114021359 |
|---|---|
| LBN Legal business name | Smith, John D |
| Credentials | CRNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 8th, 2006 |
| Last updated | Jan 25th, 2024 - about 10 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114021359 | NPPES |
| Mississippi | MEDICAID | 003101732 | |
| Mississippi | Other | 5707330001 |
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