Provider Demographics
NPI:1982676540
Name:SCHMIDT, JENNIFER JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JEAN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SKYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7461
Mailing Address - Country:US
Mailing Address - Phone:919-367-0858
Mailing Address - Fax:
Practice Address - Street 1:111 ADVENT CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7087
Practice Address - Country:US
Practice Address - Phone:919-468-6820
Practice Address - Fax:919-468-6484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126ETMedicaid
NC240142BMedicare ID - Type Unspecified
NCH13272Medicare UPIN