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General NPI Number Information
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NPI Number | 1689209223
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Entity Type | Individual
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Provider Name | JAMIE NICOLE SMITH ATC
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Gender | Female
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 720 W US HIGHWAY 18
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City | GARNER
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State | IA
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Zip | 50438-1022
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Country | US
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Telephone | 641-924-0205
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Fax |
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Provider Business Mailing Address
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Address Line | 720 W US HIGHWAY 18
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City | GARNER
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State | IA
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Zip | 50438-1022
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Country | US
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Telephone | 641-924-0205
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Fax | 641-924-0207
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001701
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License Number State | IA
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