Loretta Jean Smith, FNP
Individual provider Active NPI Family Nurse Practitioner · Guntown, MS
NPI 1457533424 · NPPES record last updated May 10, 2013
Key facts
- NPI
- 1457533424
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R855649 (MS)
- Practice address
- 571 Mitchell Road
Guntown, MS 38849 - Phone
- (662) 348-2002
- Fax
- (662) 348-2001
- NPI assigned
- Dec 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Redmed LLC
Practice addresses (Care Compare)
12 Brookes Xing
Pontotoc, MS 38863-1009
Phone (662) 489-4044
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081010000351 | MS | Practitioner - Nurse Practitioner | 2860568391 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R855649 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Redmed, LLC | Current |
Accepting new patients | |
| Redmed, LLC | Current |
Accepting new patients | |
| Adults & Children Medical Clinic | Past | Accepting new patients |
Locations
171 Lakewood Dr
Batesville, MS 38606
Phone (662) 234-6464
1250 E Commerce St
Hernando, MS 38632
Phone (662) 298-2238
188 Starlyn Ave
New Albany, MS 38652
Phone (662) 486-2700
6674 Goodman Rd
Olive Branch, MS 38654
Phone (662) 985-7806
1902B Jackson Ave W
Oxford, MS 38655
Phone (662) 234-6464
1902 Jackson Ave W
#B
Oxford, MS 38655
Phone (662) 234-6464
12 Brookes Crossing
Pontotoc, MS 38863
Phone (662) 489-4044
105 Quality Ln
#A
Senatobia, MS 38668
Phone (662) 298-2144
105A Quality Ln
Ste A
Senatobia, MS 38668
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R855649 | MS | Yes |
Addresses
Primary practice location
571 Mitchell Road
Guntown, MS 38849
Mailing address
PO Box 156
Guntown, MS 38849-0156
Phone (662) 348-2002
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00631368 | Medicaid | MS |
Other names
- Mrs. Loretta Jean Fillyaw
Other providers in Guntown, MS
- Fulumirani McCoy
- Kevin Oneal Miller
- Mary Katherine Oglesby
- Jennifer T Porter
- Brenda Sensing
- Ashlyn Elena Stevens
- Austin Tyler Walker
All providers in Guntown, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.