Provider Demographics
NPI:1285939629
Name:SMITH, ALLICIA ANNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ALLICIA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5936 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8711
Mailing Address - Country:US
Mailing Address - Phone:601-559-7662
Mailing Address - Fax:
Practice Address - Street 1:1088 FLYNT DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8886
Practice Address - Country:US
Practice Address - Phone:601-932-8064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-16
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP325545164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse