Healthcare Provider Details

I. General information

NPI: 1508274028
Provider Name (Legal Business Name): JENNIFER J SMITH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 03/07/2023
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BOISE AVE
LOVELAND CO
80538-5006
US

IV. Provider business mailing address

2000 BOISE AVE
LOVELAND CO
80538-5006
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-3894
  • Fax: 970-810-3897
Mailing address:
  • Phone: 970-810-3894
  • Fax: 970-810-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3998
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3998
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: