Provider Demographics
NPI:1477595916
Name:SMOOT, JEANNE BETZ (CRNP)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:BETZ
Last Name:SMOOT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:BETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:198 THOMAS JOHNSON DRIVE, SUITE 5
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-624-5390
Mailing Address - Fax:301-624-5393
Practice Address - Street 1:915 TOLL HOUSE AVE STE 103
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5911
Practice Address - Country:US
Practice Address - Phone:410-328-6403
Practice Address - Fax:410-328-6405
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR112789363LG0600X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD613335-01OtherBLUE CROSS/BLUE SHIELD
MD699065700Medicaid
MD699065700Medicaid
MD349LC590Medicare PIN
MD500020505Medicare PIN