Healthcare Provider Details

I. General information

NPI: 1952813487
Provider Name (Legal Business Name): JESSICA LORRAINE SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 03/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S 8TH ST STE B
DEMING NM
88030-4037
US

IV. Provider business mailing address

1833 LAS TUNAS DR
LAS CRUCES NM
88011-4956
US

V. Phone/Fax

Practice location:
  • Phone: 575-543-7200
  • Fax: 575-543-7250
Mailing address:
  • Phone: 575-571-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70905
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: