Provider Demographics
NPI:1295722791
Name:SMOLIK, JAIME RAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:RAE
Last Name:SMOLIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4925
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-4925
Mailing Address - Country:US
Mailing Address - Phone:515-358-0100
Mailing Address - Fax:515-358-0109
Practice Address - Street 1:1111 - 6TH AVE - EAST TOWER
Practice Address - Street 2:SUITE B1
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2613
Practice Address - Country:US
Practice Address - Phone:515-358-0100
Practice Address - Fax:515-358-0109
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA001440363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP64361Medicare UPIN