Provider Demographics
NPI:1528883667
Name:SMITH, ALISON EDGE (MSN, PMHNP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:EDGE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:KATHERYN
Other - Last Name:EDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:730 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:TN
Mailing Address - Zip Code:38057-8797
Mailing Address - Country:US
Mailing Address - Phone:901-209-9644
Mailing Address - Fax:
Practice Address - Street 1:8626 AIRWAYS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-2603
Practice Address - Country:US
Practice Address - Phone:662-772-5937
Practice Address - Fax:662-772-5940
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN200003216163W00000X
TN201519163W00000X
MARN2341849163W00000X
COC-RXN.0102578-C-NP363LP0808X
COC-APN.0103720-C-NP363LP0808X
TN38181363LP0808X
MS907210363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse