Smith, Jackie

Smith, Jackie is an individual health care provider with primary practice located at 215 Central Ave Ste 100 , Louisville KY 40208-1450. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Smith, Jackie can be contacted via phone (502) 588-8720.

Contact Information

Primary practice address
215 Central Ave Ste 100 Louisville KY 40208-1450
Phone: (502) 588-8720
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 3009478 Kentucky
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 3009478 Kentucky

Profile Details

NPI number 1588030688
LBN Legal business name Smith, Jackie
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2015
Last updated Apr 28th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1588030688 NPPES
Kentucky MEDICAID 7100373600

Popular Providers