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General NPI Number Information
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NPI Number | 1073006672
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Entity Type | Individual
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Provider Name | MOLLY BEADLE SMITH PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 5400 EXCELSIOR BLVD STE 150
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2913
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Country | US
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Telephone | 952-993-1000
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Fax | 952-993-1160
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Provider Business Mailing Address
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Address Line | 3100 W LAKE ST UNIT 527
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City | MINNEAPOLIS
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State | MN
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Zip | 55416-2098
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Country | US
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Telephone | 612-670-0747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 14341
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085008251
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14341
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License Number State | MN
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