Healthcare Provider Details

I. General information

NPI: 1487793774
Provider Name (Legal Business Name): KATHERINE TERESA SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/14/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17201 WRIGHT STREET SUITE 200
OMAHA NE
68130
US

IV. Provider business mailing address

17445 ARBOR STREET SUITE 310
OMAHA NE
68130
US

V. Phone/Fax

Practice location:
  • Phone: 402-334-4773
  • Fax: 402-330-7463
Mailing address:
  • Phone: 402-572-3535
  • Fax: 402-572-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1301
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: