Provider Demographics
NPI:1750786620
Name:SMOOT, JENNIFER (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SMOOT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-221-5965
Mailing Address - Fax:432-221-5981
Practice Address - Street 1:2104 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-3714
Practice Address - Country:US
Practice Address - Phone:575-748-1599
Practice Address - Fax:575-208-7284
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCNP-02511OtherLICENSE NUMBER