Provider Demographics
NPI:1790940294
Name:SMITH, JAMIE N (MPH, PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPH, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 MOSS ST
Mailing Address - Street 2:STE F
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-6107
Mailing Address - Country:US
Mailing Address - Phone:337-706-8986
Mailing Address - Fax:337-706-8714
Practice Address - Street 1:3414 MOSS ST
Practice Address - Street 2:STE F
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-6107
Practice Address - Country:US
Practice Address - Phone:337-706-8986
Practice Address - Fax:337-706-8714
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1882097Medicaid