Provider Demographics
NPI:1598124976
Name:SMITH, JAMIE LYNN (LAC LMT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 W HIGHWAY 290
Mailing Address - Street 2:#106
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8819
Mailing Address - Country:US
Mailing Address - Phone:512-636-3956
Mailing Address - Fax:
Practice Address - Street 1:5611 W HIGHWAY 290
Practice Address - Street 2:#106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8819
Practice Address - Country:US
Practice Address - Phone:512-636-3956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01670171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist