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General NPI Number Information
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NPI Number | 1295306488
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Entity Type | Individual
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Provider Name | JASMINE DOMINIQUE SMITH NP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 11777 LEBANON RD
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City | FRISCO
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State | TX
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Zip | 75035-6295
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Country | US
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Telephone | 561-841-1213
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Fax |
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Provider Business Mailing Address
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Address Line | 1246 KIRK CIR
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City | GREENVILLE
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State | MS
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Zip | 38701-6315
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Country | US
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Telephone | 662-379-1222
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1049367
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 904359
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1049367
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License Number State | TX
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