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NPI Code Detail

MEDICARE: JANNIS SMITH

MEDICARE: JANNIS SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1366807265
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANNIS SMITH
Provider Business Mailing Address
First Line : 2808 EVANGELINE ST
Second Line :
City : MONROE
State : LA
Zip : 71201-3750
Country : US
Telephone Number : 318-325-9503
Fax Number :
Provider Business Practice Location Address
First Line : 2808 EVANGELINE ST
Second Line :
City : MONROE
State : LA
Zip : 71201-3750
Country : US
Telephone Number : 318-325-9503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2015
Last Update Date : 06/01/2023

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Directions to “ JANNIS SMITH ” Practice Location

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