Provider Demographics
NPI:1033742457
Name:SMITH, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-6934
Mailing Address - Country:US
Mailing Address - Phone:989-953-5320
Mailing Address - Fax:989-953-5329
Practice Address - Street 1:2790 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-6934
Practice Address - Country:US
Practice Address - Phone:989-953-5320
Practice Address - Fax:989-953-5329
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program