MEDICARE: MS. HEATHER MARIE SMITH PA

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
1	363A00000X	Physician Assistant	PA11995	CA

General Provider Information

NPI Number	:	1285902494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER MARIE SMITH PA

Provider Business Mailing Address
First Line	:	25 INTERNATIONAL BLVD
Second Line	:
City	:	MILL SPRING
State	:	NC
Zip	:	28756-0269
Country	:	US
Telephone Number	:	661-373-4769
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 EARL RD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-6700
Country	:	US
Telephone Number	:	704-481-0555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	10/07/2022

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