Healthcare Provider Details

I. General information

NPI: 1790729739
Provider Name (Legal Business Name): ANGELA M SMITHA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 EASTERN BYP MEDICAL BUILDING 2 SUITE 5
RICHMOND KY
40475-2406
US

IV. Provider business mailing address

795 EASTERN BYP MEDICAL BUILDING 2 SUITE 5
RICHMOND KY
40475-2406
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-2229
  • Fax:
Mailing address:
  • Phone: 859-624-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA050
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: