Provider Demographics
NPI:1952813487
Name:SMITH, JESSICA LORRAINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LORRAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4956
Mailing Address - Country:US
Mailing Address - Phone:575-571-0755
Mailing Address - Fax:
Practice Address - Street 1:905 S 8TH ST STE B
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4037
Practice Address - Country:US
Practice Address - Phone:575-543-7200
Practice Address - Fax:575-543-7250
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily