Healthcare Provider Details

I. General information

NPI: 1801456421
Provider Name (Legal Business Name): CARISSA ANTONIA POKRANT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CARISSA ANTONIA SMITH

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SHENANGO VALLEY FAMILY MEDICINE 2000 MEMORIAL DR, SUITE B
FARRELL PA
16121
US

IV. Provider business mailing address

2000 MEMORIAL DR STE B
FARRELL PA
16121-1366
US

V. Phone/Fax

Practice location:
  • Phone: 724-983-7507
  • Fax:
Mailing address:
  • Phone: 724-528-2513
  • Fax: 724-528-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS022184
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: