Provider Demographics
NPI:1194541698
Name:SMITH, JAMIE LEA
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEA
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:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:AK
Mailing Address - Zip Code:99921-0646
Mailing Address - Country:US
Mailing Address - Phone:907-629-4140
Mailing Address - Fax:888-349-6205
Practice Address - Street 1:LOT 3 BLOCK 7
Practice Address - Street 2:
Practice Address - City:NAUKATI BAY
Practice Address - State:AK
Practice Address - Zip Code:99950
Practice Address - Country:US
Practice Address - Phone:907-629-4140
Practice Address - Fax:888-349-6205
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator