Jackie Smith, RN

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2018029056 Issued in MO

Practice address

4429 S River Blvd Ste B
Independence, MO 64055-4659

Phone

(816) 768-0090

Fax

(816) 912-1739

NPI assigned

Sep 13, 2024

Last updated

Sep 13, 2024By the provider in NPPES

Sex

Female

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

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bridgeway Clinics LLC

  • Clinic/Center
  • Independence, MO
  • NPI 1609510809

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1726185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1568298628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4429 S RIVER BLVD STE B",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640554659",
            "telephone_number": "816-768-0090",
            "fax_number": "816-912-1739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4429 S RIVER BLVD STE B",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640554659",
            "telephone_number": "816-768-0090",
            "fax_number": "816-912-1739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACKIE",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-13",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2018029056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia K Sluder, MSW, LCSW
• Shelby Smiley, FNP-C
• Caitlin R Smith, MS, LPC
• Daniel Smith, PT
• Destiny Smith
• Jared B Smith, MD
• John Paul Smith, DDS
• Katie Smith, PLPC
• Katrena M Smith, PLPC
• Katrina Smith, M.S. CCC SLP

• Psychiatry Physician in Independence, MO
• Providers in Independence, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; 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.