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General NPI Number Information
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NPI Number | 1114490687
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Entity Type | Individual
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Provider Name | ELIZABETH BROOKE JOHNSON SMITH PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 5241 SIX FORKS RD STE 100
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City | RALEIGH
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State | NC
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Zip | 27609-4431
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Country | US
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Telephone | 919-785-3400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52411
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City | PHOENIX
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State | AZ
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Zip | 85072-2411
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Country | US
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Telephone | 919-785-3400
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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 | 0010-08724
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License Number State | NC
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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 | 0010-08724
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License Number State | NC
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