Healthcare Provider Details

I. General information

NPI: 1255154563
Provider Name (Legal Business Name): CALLIE RENE SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16126 NC HWY 50 NORTH
GARNER NC
27529
US

IV. Provider business mailing address

PO BOX 803854
KANSAS CITY MO
64180-3854
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-1425
  • Fax:
Mailing address:
  • Phone: 919-350-0351
  • Fax: 919-350-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16435
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-16435
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: