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General NPI Number Information
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NPI Number | 1952809295
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Entity Type | Individual
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Provider Name | JACQUELINE ANNE SMITH
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Gender | Female
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 1012 STATE ROUTE 521 STE 101B
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City | DELAWARE
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State | OH
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Zip | 43015-8003
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Country | US
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Telephone | 740-417-4977
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Fax | 740-990-0004
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Provider Business Mailing Address
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Address Line | 9490 EMERSON DR
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City | POWELL
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State | OH
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Zip | 43065-8021
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Country | US
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Telephone | 419-937-7287
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Fax | 740-990-0004
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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 | APRN.CNP.022255
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License Number State | OH
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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 | APRN.CNP.022255
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License Number State | OH
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