Individual
MR. JERRY SOLON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4787 ALBEN BARKLEY DRIVE, PADUCAH, KY 42002
(270) 442-9461
(270) 441-0079
Mailing address
510 LINCOLN DRIVE, HERRIN, IL 62948
(618) 997-6800
(618) 997-1187
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1645
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100226410
—
KY
Enumeration date
06/15/2011
Last updated
06/08/2015
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