MEDICARE: JAYDA SMITH LPN

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	164W00000X	Licensed Practical Nurse	42108	WV

General Provider Information

NPI Number	:	1932924024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYDA SMITH LPN

Provider Business Mailing Address
First Line	:	2157 GREENBRIER ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-9623
Country	:	US
Telephone Number	:	304-553-0051
Fax Number	:

Provider Business Practice Location Address
First Line	:	2157 GREENBRIER ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-9623
Country	:	US
Telephone Number	:	304-553-0051
Fax Number	:

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

Provider Enumeration Date	:	11/22/2024
Last Update Date	:	03/04/2026

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