Provider Demographics
NPI:1740532803
Name:SMITH, JAMIE LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1340 BLAIRS FERRY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1900
Mailing Address - Country:US
Mailing Address - Phone:319-398-6575
Mailing Address - Fax:319-369-4673
Practice Address - Street 1:701 10TH ST SE
Practice Address - Street 2:MERCY OUTPATIENT PSYCHIATRY
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-369-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG-121723363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health