Provider Demographics
NPI:1215468897
Name:SMITH, JENNIFER NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4306
Mailing Address - Country:US
Mailing Address - Phone:430-200-4350
Mailing Address - Fax:855-903-3930
Practice Address - Street 1:5904 SUMMERFIELD DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4306
Practice Address - Country:US
Practice Address - Phone:430-200-4350
Practice Address - Fax:855-903-3930
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142542363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily