Victor Oneil Smith, CEO/COO

Primary specialty

Adult CompanionTaxonomy code 372600000X

License

421763537 Issued in MS

Practice address

121 Colonial GLN
Jackson, MS 39211-3305

Phone

(601) 573-8651

NPI assigned

Nov 26, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Golden Years Adult Health Services

  • Adult Companion
  • Jackson, MS
  • NPI 1154726107
  NPD (past) Authorized official

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

{
    "created_epoch": "1448496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448496000000",
    "number": "1407220627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 COLONIAL GLN",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392113305",
            "telephone_number": "601-573-8651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 COLONIAL GLN",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392113305",
            "telephone_number": "601-573-8651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "VICTOR",
        "middle_name": "ONEIL",
        "name_prefix": "Mr.",
        "credential": "CEO/COO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-26",
        "last_updated": "2015-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "MS",
            "license": "421763537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "501 (C) (3) ORGANIZATION",
            "identifier": "421763537",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Ciara Smith, MSN, APRN, FNP-C
• Triston Ezekiel Smith, MD
• Tyesha Smith, ALL
• Ulanda Eyvette Smith, LPTA
• Vanessa Atkinson Smith, MS, CCC-SLP
• Yolanda Smith
• Yolonda Coleman Smith, AGACNP
• Lynne E Smithhart
• Erica Smolinski, PHD
• Brenda L Smoot, FNP

• Adult Companion in Jackson, MS
• Providers in Jackson, MS by specialty
• Adult Companion in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2015; 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.