Provider Demographics
NPI:1861722043
Name:SMITH, JERICA SUZANNE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JERICA
Middle Name:SUZANNE
Last Name:SMITH
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 1:6672 ROMINGER RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28679-9409
Mailing Address - Country:US
Mailing Address - Phone:919-336-7503
Mailing Address - Fax:
Practice Address - Street 1:400 SHADOWLINE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5089
Practice Address - Country:US
Practice Address - Phone:828-268-1187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC214162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner