Provider Demographics
NPI:1780111815
Name:SMITH, JENNIFER SCOTT
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SCOTT
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 1:8917 LAURISTON PL
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9775
Mailing Address - Country:US
Mailing Address - Phone:704-819-6645
Mailing Address - Fax:
Practice Address - Street 1:8917 LAURISTON PL
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9775
Practice Address - Country:US
Practice Address - Phone:704-819-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner