Healthcare Provider Details

I. General information

NPI: 1508273301
Provider Name (Legal Business Name): BROOKE SMITH PA-C, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE GRIFFIN ATC, LAT

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N 175TH ST
SHORELINE WA
98133-5064
US

IV. Provider business mailing address

7600 EVERGREEN WAY
EVERETT WA
98203-6421
US

V. Phone/Fax

Practice location:
  • Phone: 206-401-3128
  • Fax: 206-401-3201
Mailing address:
  • Phone: 206-860-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61363785
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: