Provider Demographics
NPI:1134468614
Name:SMITH, JENNIFER KATE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KATE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 LITTLE NAHANT RD
Mailing Address - Street 2:
Mailing Address - City:NAHANT
Mailing Address - State:MA
Mailing Address - Zip Code:01908-1029
Mailing Address - Country:US
Mailing Address - Phone:401-316-0708
Mailing Address - Fax:
Practice Address - Street 1:46 LITTLE NAHANT RD
Practice Address - Street 2:
Practice Address - City:NAHANT
Practice Address - State:MA
Practice Address - Zip Code:01908-1029
Practice Address - Country:US
Practice Address - Phone:401-316-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant