Healthcare Provider Details

I. General information

NPI: 1306796206
Provider Name (Legal Business Name): JESSICA SUE-ELLEN SMITH PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DIXIE DR STE 108
KETTERING OH
45409-1532
US

IV. Provider business mailing address

253 AUTUMN CT
ENGLEWOOD OH
45315-7746
US

V. Phone/Fax

Practice location:
  • Phone: 937-206-2472
  • Fax: 937-871-4586
Mailing address:
  • Phone: 937-206-2472
  • Fax: 937-871-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0041333
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: