Healthcare Provider Details

I. General information

NPI: 1164425260
Provider Name (Legal Business Name): MIKAL ANN SMOKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/26/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SAN MATEO BLVD SE
ALBUQUERQUE NM
87108-2921
US

IV. Provider business mailing address

6100 PAN AMERICAN FRWY NE
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-7333
  • Fax: 505-462-7333
Mailing address:
  • Phone: 505-823-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2004-0021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: