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General NPI Number Information
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NPI Number | 1275907396
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Entity Type | Individual
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Provider Name | MICHAEL JAY SMITH NP
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Gender | Male
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 100 AIRPORT RD
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City | KINSTON
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State | NC
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Zip | 28501-1604
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Country | US
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Telephone | 252-522-7954
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Fax |
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Provider Business Mailing Address
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Address Line | 129 LAFOY DR
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City | CLAYTON
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State | NC
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Zip | 27527-6622
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Country | US
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Telephone | 919-357-1677
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5008208
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License Number State | NC
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