Smith, Jacob Payne

Smith, Jacob Payne is an individual health care provider with primary practice located at 77 W Forest Ave Ste 117 , Flagstaff AZ 86001-1482. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is his primary health care specialty. Smith, Jacob Payne can be contacted via phone (928) 773-2505.

Contact Information

Primary practice address
77 W Forest Ave Ste 117 Flagstaff AZ 86001-1482
Phone: (928) 773-2505
Fax: (928) 773-2504
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 203222 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 100091 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 0940 Arizona

Profile Details

NPI number 1275801870
LBN Legal business name Smith, Jacob Payne
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 9th, 2011
Last updated Sep 24th, 2018 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275801870 NPPES
Colorado MEDICAID 274331YPVE

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