Individual ProviderJerry Wayne SmithPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2801 W Kinnickinnic River Pkwy, Suite 570, Milwaukee, WI 53215-3669(414) 385-8780PECOS EnrollmentBased on the most recent information from CMS, provider Jerry Wayne Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:26 AM.Profile DetailsProvider ID1457392573Provider TypeIndividualFull NameSmith, Jerry WayneCredentialPAGenderMaleEnumeration Date6/9/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address2801 W Kinnickinnic River Pkwy, Suite 570, Milwaukee, WI 53215-3669Phone(414) 385-8780FaxUnlisted FaxMailing LocationMailing AddressN106w7320 Chatham St, Cedarburg, WI 53012-3246PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense10-023Wisconsin