Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2998 | WV |
Y | 207R00000X | Internist | 2998 | WV |
Y | 111NI0900X | Internist | 2998 | WV |
NPI | 1124381488 |
---|---|
Provider Name | Jessica B. Smith-Kelly |
First Address | Lewisburg, WV 24901-1380 |
Second Address | Lewisburg, WV 24901-1380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 03/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1124381488 | (05) | WV |