Active NPI
Kathryn Derivaux Smith, D.D.S.
- General Practice Dentistry
- Horn Lake, MS
National Provider Identifier
1962885483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3814-15
- Practice address
- 2154 Goodman Rd W
Horn Lake, MS 38637-1303 - Phone
- (662) 393-9200
- NPI assigned
- Jul 1, 2015
- Last updated
- Jul 1, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3814-15 | MS | Primary |
Addresses
Primary practice location
2154 Goodman Rd W
Horn Lake, MS 38637-1303
Mailing address
1275 Fleets Harbor Dr
Memphis, TN 38103-8991
Phone (601) 573-2007
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 |
|---|---|---|---|
| 3814-15 | MS | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Happy Smiles LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435708800000",
"number": "1962885483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1275 FLEETS HARBOR DR",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381038991",
"telephone_number": "601-573-2007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2154 GOODMAN RD W",
"city": "HORN LAKE",
"state": "MS",
"postal_code": "386371303",
"telephone_number": "662-393-9200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "KATHRYN",
"middle_name": "DERIVAUX",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-01",
"last_updated": "2015-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MS",
"license": "3814-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Horn Lake, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.