Healthcare Provider Details

I. General information

NPI: 1154655975
Provider Name (Legal Business Name): REBECCA A SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13402 W COAL MINE AVE STE 300
LITTLETON CO
80127-5407
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-963-0566
  • Fax:
Mailing address:
  • Phone: 303-716-8018
  • Fax: 303-763-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2878
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: