MEDICARE: JESSICA LYNN SMITH N.P.

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	363L00000X	Nurse Practitioner	4704199299	MI

General Provider Information

NPI Number	:	1578523387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN SMITH N.P.

Provider Business Mailing Address
First Line	:	4459 GREAT OAKS DR
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4459 GREAT OAKS DR
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8665
Country	:	US
Telephone Number	:	810-287-8506
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	01/27/2023

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