Provider Demographics
NPI:1891191672
Name:SMITH, JAROD (DNP, ARNP,FN)
Entity Type:Individual
Prefix:
First Name:JAROD
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DNP, ARNP,FN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NE CIRCLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4256
Mailing Address - Country:US
Mailing Address - Phone:541-286-4742
Mailing Address - Fax:833-450-5933
Practice Address - Street 1:800 NE CIRCLE BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4256
Practice Address - Country:US
Practice Address - Phone:541-286-4742
Practice Address - Fax:833-450-5933
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201407551NP-PP363LF0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily