MEDICARE: JANIS KATHREN 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		TX

General Provider Information

NPI Number	:	1992046676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIS KATHREN SMITH

Provider Business Mailing Address
First Line	:	1801 INWOOD ROAD WA1
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-8883
Country	:	US
Telephone Number	:	214-645-3300
Fax Number	:	214-645-3301

Provider Business Practice Location Address
First Line	:	1801 INWOOD ROAD WA1
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-8883
Country	:	US
Telephone Number	:	214-645-3300
Fax Number	:	214-645-3301

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

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	03/06/2013

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Directions to “ JANIS KATHREN SMITH ” Practice Location

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