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NPI Code Detail

MEDICARE: MS. PEGGIE A SMITH PA-C

MEDICARE: MS. PEGGIE A 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
1363A00000XPhysician AssistantPA1394NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
212509167OTHERCAQH

General Provider Information

NPI Number : 1053383331
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PEGGIE A SMITH PA-C
Provider Business Mailing Address
First Line : 850 HARVARD WAY
Second Line :
City : RENO
State : NV
Zip : 89502-2055
Country : US
Telephone Number : 775-982-5262
Fax Number : 775-982-5496
Provider Business Practice Location Address
First Line : 75 PRINGLE WAY STE 401
Second Line :
City : RENO
State : NV
Zip : 89502-1476
Country : US
Telephone Number : 775-982-5000
Fax Number : 775-982-2973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 11/16/2017

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Directions to “ MS. PEGGIE A SMITH PA-C” Practice Location

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