MEDICARE: MRS. JENNIFER SMITH FNP

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	5005946	NC

General Provider Information

NPI Number	:	1639413461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER SMITH FNP

Provider Business Mailing Address
First Line	:	3836 CHADBORNE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28312-7609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4092 PROFESSIONAL DR
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-2366
Country	:	US
Telephone Number	:	910-615-3120
Fax Number	:	910-423-6050

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

Provider Enumeration Date	:	11/16/2012
Last Update Date	:	03/05/2015

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