Provider Demographics
NPI:1154460160
Name:SMITH, JESSICA KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:KYLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:4602 JCP UNIVERSITY OF IOWA HOSPITALS AND CLINICS
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1007
Mailing Address - Country:US
Mailing Address - Phone:319-384-7359
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:4602 JCP UNIVERSITY OF IOWA HOSPITALS AND CLINICS
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1007
Practice Address - Country:US
Practice Address - Phone:319-384-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0241208600000X
CAA104503208600000X
IA38649208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI09230278Medicare PIN
IAP00769169Medicare PIN