Healthcare Provider Details

I. General information

NPI: 1295584316
Provider Name (Legal Business Name): MOLLY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GREEN PARK LN
CARY NC
27518-9769
US

IV. Provider business mailing address

101 GREEN PARK LN
CARY NC
27518-9769
US

V. Phone/Fax

Practice location:
  • Phone: 919-600-0505
  • Fax:
Mailing address:
  • Phone: 919-600-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16074
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: