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NPI Code Detail

MEDICARE: MISS PHAEDRA JOLENE SMITH HIGH SCHOOL DIPLOMA

MEDICARE: MISS PHAEDRA JOLENE SMITH HIGH SCHOOL DIPLOMA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1427791235
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS PHAEDRA JOLENE SMITH HIGH SCHOOL DIPLOMA
Provider Business Mailing Address
First Line : 709 N HIGH ST
Second Line :
City : MOUNT ORAB
State : OH
Zip : 45154-6501
Country : US
Telephone Number : 937-444-6127
Fax Number : 937-444-6192
Provider Business Practice Location Address
First Line : 709 N HIGH ST
Second Line :
City : MOUNT ORAB
State : OH
Zip : 45154-6501
Country : US
Telephone Number : 937-444-6127
Fax Number : 937-444-6192
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2022
Last Update Date : 05/24/2022

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Directions to “ MISS PHAEDRA JOLENE SMITH HIGH SCHOOL DIPLOMA” Practice Location

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