Basic Information
| Provider Information | |||||||||
| NPI: | 1407843261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMYTH | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | KEHREN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KEHREN | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2817 REILLY ROAD | ||||||||
| Address2: | WOMACK ARMY MEDICAL CENTER | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109077333 | ||||||||
| FaxNumber: | 9109078485 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING DRIVE, CB 7070 | ||||||||
| Address2: | G0412 NEUROSCIENCES HOSPITAL | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199663342 | ||||||||
| FaxNumber: | 9199667941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 10/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 2005-01634 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.