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Individual

MR. JAYSON PAUL SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
N.P.

Contact information

Practice address
4971 W OVERLAND RD, BOISE, ID 83705-2822
(208) 472-5050
(208) 472-5051
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
65851
ID
363LN0000X
Neonatal Nurse Practitioner
65851
ID
363LP0200X
Pediatric Nurse Practitioner
65851
ID
363LP2300X
Primary Care Nurse Practitioner
65851
ID

Other

Enumeration date
10/14/2020
Last updated
09/02/2022
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