Provider Demographics
NPI:1598943821
Name:SMITH, JENNIFER MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2721 W 6TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4302
Mailing Address - Country:US
Mailing Address - Phone:785-200-3535
Mailing Address - Fax:785-783-0187
Practice Address - Street 1:2721 W 6TH ST STE E
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4302
Practice Address - Country:US
Practice Address - Phone:785-200-3535
Practice Address - Fax:785-783-0187
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52377207Q00000X
KS05-36993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine