Healthcare Provider Details

I. General information

NPI: 1952324246
Provider Name (Legal Business Name): TONI SMITH-WHITEEAGLE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI SMITH

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 LIVE OAK ST
GREENVILLE TX
75402
US

IV. Provider business mailing address

5005 LIVE OAK ST
GREENVILLE TX
75402
US

V. Phone/Fax

Practice location:
  • Phone: 903-455-3500
  • Fax: 903-455-3509
Mailing address:
  • Phone: 903-455-3500
  • Fax: 903-455-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: