Provider Demographics
NPI:1336115138
Name:SMITH, JEFFREY JAMES (CRNA)
Entity Type:Individual
Prefix:PROF
First Name:JEFFREY
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 TARTAN DR
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-3554
Mailing Address - Country:US
Mailing Address - Phone:724-548-4674
Mailing Address - Fax:
Practice Address - Street 1:140 TARTAN DR
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-3554
Practice Address - Country:US
Practice Address - Phone:724-548-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN509400L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101304792Medicaid
PA101304792Medicaid
PA084944FEVMedicare ID - Type Unspecified