Individual
MS. JACKALYNN THERESE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1397 GALLERIA DR, HENDERSON, NV 89014-6661
(702) 436-5800
(702) 436-2420
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
816978
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194575266
—
NV
01
—
816978
STATE LICENSE
NV
Enumeration date
03/25/2024
Last updated
07/08/2024
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