Healthcare Provider Details

I. General information

NPI: 1356079727
Provider Name (Legal Business Name): JARED SMITH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 N BRIDGE ST
CHILLICOTHEE OH
45601-1704
US

IV. Provider business mailing address

1514 HAWTHORN DR
PORTSMOUTH OH
45662-2323
US

V. Phone/Fax

Practice location:
  • Phone: 740-772-5050
  • Fax:
Mailing address:
  • Phone: 740-981-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number363LA2100X
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0032187
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: