Healthcare Provider Details

I. General information

NPI: 1205809423
Provider Name (Legal Business Name): JENNIFER H SMART DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 BROAD STREET
ORIENTAL NC
28571-0769
US

IV. Provider business mailing address

PO BOX 894
ORIENTAL NC
28571-0769
US

V. Phone/Fax

Practice location:
  • Phone: 252-249-1869
  • Fax: 252-249-0112
Mailing address:
  • Phone: 252-249-1869
  • Fax: 252-249-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4279
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: