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Individual
JACQUELINE KAYE SMITH
Active
Individual
JACQUELINE KAYE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
19067
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP2917
—
SC
01
—
SC43043365
MEDICARE PIN
SC
Enumeration date
09/15/2014
Last updated
12/23/2020
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