Jason Smith, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

APN.0993876-NP Issued in CO

Practice address

413 Sanner St
Edwardsville, IL 62025-1080

Phone

(618) 203-3733

NPI assigned

Jul 18, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531872000000",
    "number": "1033695564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 SANNER ST",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620251080",
            "telephone_number": "618-203-3733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 SANNER ST",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620251080",
            "telephone_number": "618-203-3733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JASON",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-18",
        "last_updated": "2018-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "APN.0993876-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Michelle Skillman Holtgrave
• Mark S Slaughter, PT
• Judy Ann Slosar
• Alexander Joseph Smith
• Brandy Lynn Smith, LCPC
• Vanessa Smith
• Clayton Allen Snyders, RN
• Ellen Snyders
• Soulful Spaces Therapy PLLC
• Southern Illinois Neuropsychology LLC

• Adult Health Nurse Practitioner in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Adult Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.