| Doctor Name: | JESSICA SMITH |
| NPI Number: | 1215234968 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 4450 |
| Business Practice Address: | 1010 Highway 17 N North Myrtle Beach, SC - 295822806 |
| Business Phone Number: | 8436850180 |
| Business Fax Number: | |
| Mailing Address: | 503 Trestle Way, CONWAY |
| State: | SC |
| Postal Code: | 295267468 |
| Phone Number: | 8436850180 |
| Fax Number: | |
| NPI Enumeration Date: | 02/15/2011 |
| NPI Last Update Date: | 03/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4450 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |