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NPI Code Detail

MEDICARE: KATIE MARIE SMITH PA-C

MEDICARE: KATIE MARIE SMITH PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant2609CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11082610OTHERCONCCPA

General Provider Information

NPI Number : 1003068628
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE MARIE SMITH PA-C
Provider Business Mailing Address
First Line : 32214 ELLINGWOOD TRL
Second Line : SUITE #210
City : EVERGREEN
State : CO
Zip : 80439-9779
Country : US
Telephone Number : 303-679-2020
Fax Number :
Provider Business Practice Location Address
First Line : 32214 ELLINGWOOD TRL
Second Line : SUITE #210
City : EVERGREEN
State : CO
Zip : 80439-9779
Country : US
Telephone Number : 303-679-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2008
Last Update Date : 10/23/2012

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Directions to “ KATIE MARIE SMITH PA-C” Practice Location

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