Individual
JIMMY D SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1001 WILLOW CREEK RD STE 2200, PRESCOTT, AZ 86301-1614
(928) 445-6025
(928) 778-3026
Mailing address
1001 WILLOW CREEK RD STE 2200, PRESCOTT, AZ 86301-1614
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP2306
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084440
—
AZ
01
—
Z142983
MEDICARE
AZ
Enumeration date
05/06/2006
Last updated
03/12/2025
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