=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336291731
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY NORRIS SMITH PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 11/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12951 SOUTH FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77047-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-526-5771
-----------------------------------------------------
Fax | 713-526-2036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12951 SOUTH FWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77047-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-526-5771
-----------------------------------------------------
Fax | 713-526-2036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA04994
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------