Individual provider Active NPI

Jennifer Carol Smith, FNP-BC, APNP

  • Psychiatric/Mental Health Nurse Practitioner
  • New Berlin, WI
National Provider Identifier
1962951152
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
7291-33 Issued in WI
Practice address
4805 S Moorland Rd
New Berlin, WI 53151-7401
Phone
(262) 257-5100
NPI assigned
Sep 28, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 7291-33 WI
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 7291-33 WI Primary

Addresses

Primary practice location

4805 S Moorland Rd
New Berlin, WI 53151-7401

Mailing address

4805 S Moorland Rd
New Berlin, WI 53151-7401
Phone (414) 708-5330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7291-33WIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince May 1, 2023 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince May 1, 2023 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Apr 23, 2017 Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744

W180N8085 Town Hall Rd
Menomonee Fls, WI 53051
Phone (262) 257-5000

4805 S Moorland Rd
New Berlin, WI 53151
Phone (262) 798-7200

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1962951152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4805 S MOORLAND RD",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531517401",
            "telephone_number": "414-708-5330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 S MOORLAND RD",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531517401",
            "telephone_number": "262-257-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JENNIFER",
        "middle_name": "CAROL",
        "credential": "FNP-BC, APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-28",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "7291-33",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "7291-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Berlin, WI

Sources for this page

Verify at the official NPI Registry.