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General NPI Number Information
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NPI Number | 1285902494
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Entity Type | Individual
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Provider Name | HEATHER MARIE SMITH PA
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Gender | Female
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 419 EARL RD
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City | SHELBY
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State | NC
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Zip | 28150-6700
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Country | US
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Telephone | 704-481-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 25 INTERNATIONAL BLVD
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City | MILL SPRING
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State | NC
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Zip | 28756-0269
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Country | US
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Telephone | 661-373-4769
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA11995
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License Number State | CA
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