MEDICARE: JESSLYN 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
1	363LF0000X	Family Nurse Practitioner	1-138184	AL

General Provider Information

NPI Number	:	1518510650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSLYN SMITH

Provider Business Mailing Address
First Line	:	900 GENE TERRY RD
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36301-8584
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3144 ROSS CLARK CIR
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-3038
Country	:	US
Telephone Number	:	334-678-9123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	08/08/2023

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Directions to “ JESSLYN SMITH ” Practice Location

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