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NPI Code Detail

MEDICARE: ALLY KIERSTEN KNIGHT SMOAK PA-C

MEDICARE: ALLY KIERSTEN KNIGHT SMOAK 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 Assistant5499SC
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1508629858
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLY KIERSTEN KNIGHT SMOAK PA-C
Provider Business Mailing Address
First Line : 801 YORK ST
Second Line :
City : MANITOWOC
State : WI
Zip : 54220-4630
Country : US
Telephone Number : 920-663-9008
Fax Number : 920-684-1439
Provider Business Practice Location Address
First Line : 602 N MAIN ST
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29483-6627
Country : US
Telephone Number : 843-881-4440
Fax Number : 843-225-0110
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2024
Last Update Date : 01/12/2026

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