Healthcare Provider Details

I. General information

NPI: 1609066158
Provider Name (Legal Business Name): KAREN L SMITH MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 WEST PROSPECT AVENUE
RAEFORD NC
28376-6197
US

IV. Provider business mailing address

929 WEST PROSPECT AVENUE
RAEFORD NC
28376-6197
US

V. Phone/Fax

Practice location:
  • Phone: 910-904-1695
  • Fax: 901-904-1767
Mailing address:
  • Phone: 910-904-1695
  • Fax: 901-904-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberNC33894
License Number StateNC

VIII. Authorized Official

Name: DR. KAREN LINNEAR SMITH
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 910-904-1695