Healthcare Provider Details

I. General information

NPI: 1912491234
Provider Name (Legal Business Name): SABRINA SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SABRINA GRANTHAM PA-C

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 12/05/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30789 N RANGE AVENUE
DENHAM SPRINGS LA
70726
US

IV. Provider business mailing address

9516 AIRLINE HWY
BATON ROUGE LA
70815-5501
US

V. Phone/Fax

Practice location:
  • Phone: 225-655-6422
  • Fax: 225-341-5903
Mailing address:
  • Phone: 225-655-6422
  • Fax: 225-341-5903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number309573
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: