Active NPI
Jordan Kennedy Smith
- Pharmacist
- Lucedale, MS
National Provider Identifier
1407336571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E-15508
- Practice address
- 11228 Old 63 S
Lucedale, MS 39452-4945 - Phone
- (601) 947-4287
- NPI assigned
- Aug 18, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E-15508 | MS | Primary |
Addresses
Primary practice location
11228 Old 63 S
Lucedale, MS 39452-4945
Mailing address
8001 County Road 514
Meridian, MS 39301-9276
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E-15508 | Other | MS | LICENSE NUMBER |
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
| License | State | Type | Specialty |
|---|---|---|---|
| E-15508 | MS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534550400000",
"number": "1407336571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8001 COUNTY ROAD 514",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393019276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11228 OLD 63 S",
"city": "LUCEDALE",
"state": "MS",
"postal_code": "394524945",
"telephone_number": "601-947-4287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "JORDAN",
"middle_name": "KENNEDY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-18",
"last_updated": "2018-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-15508",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "E-15508",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lucedale, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.