Individual provider Active NPI

Mary T Smith, FNP

  • Family Nurse Practitioner
  • Flowood, MS
National Provider Identifier
1144382672
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
668699 Issued in MS
Practice address
215 Katherine Dr Ste a
Flowood, MS 39232-9588
Phone
(601) 665-4162
Fax
(888) 398-1151
NPI assigned
Dec 14, 2006
Last updated
Oct 18, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 668699 MS Primary

Addresses

Primary practice location

215 Katherine Dr Ste a
Flowood, MS 39232-9588

Mailing address

PO Box 4128
Meridian, MS 39304-4128
Phone (601) 581-7600

Other practice location 1

1818 College Drive
Meridian, MS 39307-5429
Phone (601) 581-7600

Other identifiers 1

IdentifierTypeStateIssuer
000119998MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
668699MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mississippi Band of Choctaw Indians Current Accepting new patients
Mississippi Band of Choctaw Indians CurrentSince Apr 1, 2019 Accepting new patients
Mississippi Band of Choctaw Indians Current Accepting new patients
Mississippi Band of Choctaw Indians CurrentSince Apr 1, 2019 Accepting new patients
Mississippi Band of Choctaw Indians Current Accepting new patients
Anderson Physician Alliance, Inc. Past Accepting new patients

Locations

1930 N Pearl St
Carthage, MS 39051
Phone (601) 287-6639

210 Hospital Cir
Choctaw, MS 39350
Phone (601) 389-4500

376 Campus Rd
Conehatta, MS 39057
Phone (601) 389-4500

124 Big Creek Cir
Philadelphia, MS 39350
Phone (601) 389-4500

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1144382672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4128",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393044128",
            "telephone_number": "601-581-7600",
            "fax_number": "601-483-5543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 KATHERINE DR STE A",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329588",
            "telephone_number": "601-665-4162",
            "fax_number": "888-398-1151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 College Drive",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "393075429",
            "country_code": "US",
            "telephone_number": "601-581-7600",
            "fax_number": "601-483-5543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARY",
        "middle_name": "T",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-14",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "668699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000119998",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

Verify at the official NPI Registry.