Provider Demographics
NPI:1902139322
Name:SMITH, BRIDGET M (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-5429
Mailing Address - Country:US
Mailing Address - Phone:601-616-5608
Mailing Address - Fax:601-581-7676
Practice Address - Street 1:9221 COOK RD
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:MS
Practice Address - Zip Code:39320-9516
Practice Address - Country:US
Practice Address - Phone:601-616-5608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS2126767363LF0000X
MS2009003248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08030788Medicaid