Individual
JESSICA ADELIADE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COGNITIVE INSTRUCTOR
Contact information
Practice address
1500 N MAIN ST, FREDERICK, OK 73542-1421
(580) 335-3320
Mailing address
PO BOX 129, FREDERICK, OK 73542-0129
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447688718
—
OK
Enumeration date
06/01/2018
Last updated
06/01/2018
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