Healthcare Provider Details

I. General information

NPI: 1750786620
Provider Name (Legal Business Name): JENNIFER SMOOT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 W MAIN ST
ARTESIA NM
88210-3714
US

IV. Provider business mailing address

4214 ANDREWS HWY STE 240
MIDLAND TX
79703-4817
US

V. Phone/Fax

Practice location:
  • Phone: 575-748-1599
  • Fax: 575-208-7284
Mailing address:
  • Phone: 432-221-5965
  • Fax: 432-221-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02511
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: