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General NPI Number Information
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NPI Number | 1811230493
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Entity Type | Individual
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Provider Name | KIMBERLY MICHAELLE SMITH MHS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 2315 STOCKTON BLVD RM 6312
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City | SACRAMENTO
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State | CA
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Zip | 95817
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Country | US
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Telephone | 919-368-0082
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Fax |
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Provider Business Mailing Address
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Address Line | 2942 WEALD WAY APT 2414
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City | SACRAMENTO
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State | CA
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Zip | 95833-3570
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Country | US
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Telephone | 919-368-0082
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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 | 101542
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License Number State | NC
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