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General NPI Number Information
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NPI Number | 1104497700
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Entity Type | Individual
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Provider Name | JARED EARL SMITH FNP
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Gender | Male
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Dates
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Enumeration Date | 07/05/2021
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 4720 S I 10 SERVICE RD W STE 206
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City | METAIRIE
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State | LA
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Zip | 70001-1240
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Country | US
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Telephone | 985-892-7070
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Fax | 985-892-7017
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Provider Business Mailing Address
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Address Line | PO BOX 1089
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City | HAMMOND
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State | LA
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Zip | 70404-1089
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Country | US
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Telephone | 985-892-7070
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Fax | 985-892-7017
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 220526
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License Number State | LA
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