Individual
MRS. JEAN A SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1059 BARTON DR, FORDLAND, MO 65652-7350
(417) 767-2273
(417) 767-4054
Mailing address
1059 BARTON DR, FORDLAND, MO 65652-7350
(417) 767-2273
(417) 767-4054
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
153384
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424622504
—
MO
Enumeration date
02/07/2006
Last updated
07/05/2011
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