Provider Demographics
NPI:1205445095
Name:SMITH, JEFFREY ALLEN (APRN)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1518 CHOUTEAU ST
Mailing Address - Street 2:
Mailing Address - City:FORT BENTON
Mailing Address - State:MT
Mailing Address - Zip Code:59442-9003
Mailing Address - Country:US
Mailing Address - Phone:406-622-5485
Mailing Address - Fax:406-622-5670
Practice Address - Street 1:1518 CHOUTEAU ST
Practice Address - Street 2:
Practice Address - City:FORT BENTON
Practice Address - State:MT
Practice Address - Zip Code:59442-9003
Practice Address - Country:US
Practice Address - Phone:406-622-5485
Practice Address - Fax:406-622-5670
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT160455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily