Provider Demographics
NPI:1558127621
Name:SMITH, JEFFREY LYNN SR
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LYNN
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6619 KEARNEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5846
Mailing Address - Country:US
Mailing Address - Phone:206-407-5796
Mailing Address - Fax:
Practice Address - Street 1:6619 KEARNEY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5846
Practice Address - Country:US
Practice Address - Phone:206-407-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management