Kerrie Sanders- Smith

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

875209 Issued in MS

Practice address

4077 Pemberton Square Blvd
Vicksburg, MS 39180-5580

Phone

(601) 638-8600

NPI assigned

Dec 9, 2015

Last updated

Nov 3, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Vicksburg Clinic LLC

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1790711158
  NPD
• River Oaks Management Company LLC

  • Family Medicine Physician
  • Jackson, MS
  • NPI 1922029040
  NPD (past)
• Vicksburg Clinic LLC

  • Infectious Disease Physician
  • Vicksburg, MS
  • NPI 1659307791
  NPD (past)
• Vicksburg Special Care Clinic LLC

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1487988002
  NPD (past)

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509667200000",
    "number": "1144695669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 ALFRED DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391809102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 PEMBERTON SQUARE BLVD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805580",
            "telephone_number": "601-638-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS- SMITH",
        "first_name": "KERRIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-09",
        "last_updated": "2017-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "875209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tameria Rule, NUTRITIONIST, CDE
• Karen Runnels, PT
• Denise Rush
• Keniesha Russell
• Robert A Sadler, DDS
• Jamia Kiana Sanders
• Jessica Sanders
• Leah M Sanders, PHARMD
• Triva Watts Sanders, CRC, CCSCC
• Bonny Saucier, CFNP

• Family Nurse Practitioner in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.