Provider Demographics
NPI:1184063315
Name:SMITH, JAMIE WOOD (FNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:WOOD
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:WOOD
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:5261 CARROLLTON PIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3030
Mailing Address - Country:US
Mailing Address - Phone:276-601-6197
Mailing Address - Fax:276-601-6156
Practice Address - Street 1:5261 CARROLLTON PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3030
Practice Address - Country:US
Practice Address - Phone:276-238-8876
Practice Address - Fax:276-238-8886
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184063315Medicaid
VA1184063315Medicaid
VAF0513258OtherAANPCP
DN2980OtherGROUP PTAN
VAP01210662OtherPTAN
VAVVA711AOtherPTAN
261083931OtherTAX ID