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General NPI Number Information
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NPI Number | 1194575266
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Entity Type | Individual
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Provider Name | JACKALYNN THERESE SMITH FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 1397 GALLERIA DR
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City | HENDERSON
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State | NV
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Zip | 89014-6661
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Country | US
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Telephone | 702-436-5800
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Fax | 702-436-2420
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Provider Business Mailing Address
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Address Line | 6355 S BUFFALO DR FL 3
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City | LAS VEGAS
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State | NV
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Zip | 89113-2133
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Country | US
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Telephone | 702-216-3346
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Fax | 702-671-6883
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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 | 816978
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License Number State | NV
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