MEDICARE: MS. CARLI SMITH

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

General Provider Information

NPI Number	:	1528631702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLI SMITH

Provider Business Mailing Address
First Line	:	2809 OASIS CIR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-3228
Country	:	US
Telephone Number	:	702-917-1424
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E WINDMILL LN STE 155
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1844
Country	:	US
Telephone Number	:	702-800-2723
Fax Number	:

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

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	12/21/2021

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Directions to “ MS. CARLI SMITH ” Practice Location

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