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General NPI Number Information
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NPI Number | 1912630377
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Entity Type | Individual
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Provider Name | JESSICA BUCK SMITH FNPC
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Gender | Female
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 4787 HIGHWAY 151
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City | DOWNSVILLE
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State | LA
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Zip | 71234-5145
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Country | US
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Telephone | 985-805-6068
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Fax | 504-930-4019
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Provider Business Mailing Address
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Address Line | PO BOX 792
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City | BASTROP
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State | LA
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Zip | 71221-0792
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Country | US
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Telephone |
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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 | 226521
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License Number State | LA
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