1427289677 NPI number — MR. LORING JOHN SMITH JR. PMHNP-BC

Table of content: MR. LORING JOHN SMITH JR. PMHNP-BC (NPI 1427289677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427289677 NPI number — MR. LORING JOHN SMITH JR. PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
LORING
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427289677
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1641 POPPS FERRY RD STE A3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILOXI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39532-2226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-232-0890
Provider Business Mailing Address Fax Number:
228-232-0891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 VETERANS AVE
Provider Second Line Business Practice Location Address:
BLDG. T-100
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39531-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-523-4784
Provider Business Practice Location Address Fax Number:
228-523-5959
Provider Enumeration Date:
08/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0809X , with the licence number:  R662992 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: R662992 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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