Healthcare Provider Details

I. General information

NPI: 1164809000
Provider Name (Legal Business Name): VALERIE SMITH FAVORS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S CARROLLTON AVE
NEW ORLEANS LA
70118-4307
US

IV. Provider business mailing address

4665 MUSIC ST
NEW ORLEANS LA
70122-5024
US

V. Phone/Fax

Practice location:
  • Phone: 504-207-3060
  • Fax: 504-207-3067
Mailing address:
  • Phone: 803-637-1500
  • Fax: 803-637-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001005497
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number303819
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: