Healthcare Provider Details

I. General information

NPI: 1376900084
Provider Name (Legal Business Name): KATHERINE SMYTH ATWOOD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE SMYTH PA-C

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 144TH ST UNIT 1
SEBASTIAN FL
32958-3206
US

IV. Provider business mailing address

2845 PGA BLVD
PALM BEACH GARDENS FL
33410-2910
US

V. Phone/Fax

Practice location:
  • Phone: 723-883-5577
  • Fax: 772-388-3557
Mailing address:
  • Phone: 561-693-0540
  • Fax: 561-296-6174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA9109329
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9109329
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: