Provider Demographics
NPI:1134888753
Name:SMITH, JANIE LYNN
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 PRIVATE ROAD 7708
Mailing Address - Street 2:
Mailing Address - City:WILLS POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75169-6773
Mailing Address - Country:US
Mailing Address - Phone:903-413-1771
Mailing Address - Fax:
Practice Address - Street 1:809 PRIVATE ROAD 7708
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-6773
Practice Address - Country:US
Practice Address - Phone:903-413-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156FX1900X
3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptist