Provider Demographics
NPI:1982202743
Name:SMITH, JAYSON PAUL (NP)
Entity Type:Individual
Prefix:MR
First Name:JAYSON
Middle Name:PAUL
Last Name:SMITH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:PAUL
Other - Last Name:JUHASZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-955-6500
Mailing Address - Fax:
Practice Address - Street 1:4971 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2822
Practice Address - Country:US
Practice Address - Phone:208-472-5050
Practice Address - Fax:208-472-5051
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID65851363LN0000X, 363LP0200X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care