Basic Information
| Provider Information | |||||||||
| NPI: | 1033700182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMYTH | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1709 HANOVER AVE APT 9 | ||||||||
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| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232203545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018619082 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 E MARSHALL ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232985023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048289000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2021 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.