Healthcare Provider Details

I. General information

NPI: 1427419357
Provider Name (Legal Business Name): JENIFER SMYER FNP-C, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2016
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E PINE ST
DEMING NM
88030-9124
US

IV. Provider business mailing address

3100 E PINE ST
DEMING NM
88030-9124
US

V. Phone/Fax

Practice location:
  • Phone: 575-567-3088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberCNP-02988
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: