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NPI Code Detail

MEDICARE: JENNIFER LYNN SMITH PAC

MEDICARE: JENNIFER LYNN SMITH PAC
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
1363A00000XPhysician Assistant9952MN
2363A00000XPhysician Assistant9950MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639163249
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNN SMITH PAC
Provider Business Mailing Address
First Line : 6445 RICHFIELD PKWY
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-6400
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 6445 RICHFIELD PKWY
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-6400
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2005
Last Update Date : 04/23/2025

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Directions to “ JENNIFER LYNN SMITH PAC” Practice Location

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