Provider Demographics
NPI:1447847157
Name:SMITH, MARSHEKA VARCHA (RN)
Entity type:Individual
Prefix:
First Name:MARSHEKA
Middle Name:VARCHA
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7296 HUNTERS FOREST DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7532
Mailing Address - Country:US
Mailing Address - Phone:662-897-9475
Mailing Address - Fax:
Practice Address - Street 1:5025 HIGHWAY 305 N
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3602
Practice Address - Country:US
Practice Address - Phone:662-890-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR897360163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse