Maria L Smith, PMHNP-BC, C-FNP, LPC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

902088 Issued in MS

Practice address

103 Southlake Cir
Canton, MS 39046-5369

Phone

(601) 824-0342

NPI assigned

Nov 15, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Madison Rankin Simpson Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brandon, MS
  • NPI 1063428761

  MS

  Medicare reassignment NPD
• Jackson Psychiatry Group

  • Psychiatric/Mental Health Nurse Practitioner
  • Ridgeland, MS
  • NPI 1790087393

  Psychiatric/Mental Health

  NPD (past)
• Jackson Psychological Group PA

  • Psychologist
  • Jackson, MS
  • NPI 1720267974
  NPD (past)

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

{
    "created_epoch": "1289779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1972804474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 KENWOOD PL",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022432",
            "telephone_number": "601-951-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SOUTHLAKE CIR",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390465369",
            "telephone_number": "601-824-0342"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5611 Highway 80 E",
            "address_purpose": "LOCATION",
            "city": "Pearl",
            "state": "MS",
            "postal_code": "392088929",
            "country_code": "US",
            "telephone_number": "601-939-6634",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "350 W Woodrow Wilson Ave Ste 1600",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392137627",
            "country_code": "US",
            "telephone_number": "601-815-6867",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "613 Marquette Rd",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "MS",
            "postal_code": "390423038",
            "country_code": "US",
            "telephone_number": "601-824-0342",
            "fax_number": "601-824-0349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARIA",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "PMHNP-BC, C-FNP, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-15",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "1056",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902088",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "902088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Amanda Slaven, LPC
• Smart Therapy, LLC
• Smilebuilders Inc
• Smith Evans
• Carla G. Smith, R.PH.
• Mary Melvin Smith, NP
• Percy L Smith Jr., PA
• Rachel Nicole Smith
• Ryan Chanler Smith, NP
• Latoya Sojourney, FNP

• Psychiatric/Mental Health Nurse Practitioner in Canton, MS
• Providers in Canton, MS by specialty
• Psychiatric/Mental Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.