Individual provider Active NPI

Victoria Roberts Smith

  • Social Worker
  • Gulfport, MS
National Provider Identifier
1154096899
Registry record updated Aug 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
4244 Issued in MS
Practice address
302 Courthouse Rd Ste G
Gulfport, MS 39507-1890
Phone
(228) 897-7465
NPI assigned
Aug 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 4244 MS Primary

Addresses

Primary practice location

302 Courthouse Rd Ste G
Gulfport, MS 39507-1890

Mailing address

860 E River PL Ste 100
Jackson, MS 39202-3442

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4244MSMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1154096899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 E RIVER PL STE 100",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392023442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 COURTHOUSE RD STE G",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395071890",
            "telephone_number": "228-897-7465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "VICTORIA",
        "middle_name": "ROBERTS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-13",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MS",
            "license": "4244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.