| NPI | 1609262278 |
|---|---|
| Former Name | JESSICA BULLOCK SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI 2240) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 19423) |
| 363L00000X Nurse Practitioner (Licence: HI 2240) | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2025-04-30 |