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Individual

JILL L JOHNSON-SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
612 N ANDOVER RD, ANDOVER, KS 67002-9778
(316) 733-6618
(316) 733-5299
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9667

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-00074
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
003719232
MEDICARE
05
100385390D
KS
Enumeration date
03/30/2006
Last updated
06/13/2014
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