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NPI Code Detail

MEDICARE: MRS. JACKIE LYNN SMITH-LAPP FNP-C

MEDICARE: MRS. JACKIE LYNN SMITH-LAPP FNP-C
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
1363LF0000XFamily Nurse Practitioner22070.1582WY

General Provider Information

NPI Number : 1619412715
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACKIE LYNN SMITH-LAPP FNP-C
Provider Business Mailing Address
First Line : 3632 AMERICAN WAY
Second Line :
City : CASPER
State : WY
Zip : 82604-3164
Country : US
Telephone Number : 307-233-7300
Fax Number :
Provider Business Practice Location Address
First Line : 3632 AMERICAN WAY
Second Line :
City : CASPER
State : WY
Zip : 82604-3164
Country : US
Telephone Number : 307-233-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2016
Last Update Date : 12/27/2016

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