Healthcare Provider Details

I. General information

NPI: 1366356891
Provider Name (Legal Business Name): JILL RAE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAE SMITH

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 E 32ND ST
SILVER CITY NM
88061-7252
US

IV. Provider business mailing address

530 DE MOSS ST
LORDSBURG NM
88045-2618
US

V. Phone/Fax

Practice location:
  • Phone: 575-800-1467
  • Fax: 575-313-8230
Mailing address:
  • Phone: 575-800-1467
  • Fax: 575-694-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: