Provider Demographics
NPI:1033126560
Name:SMITH, LAURIE (PA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 DILLINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:BARNARDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28709-9754
Mailing Address - Country:US
Mailing Address - Phone:828-626-3438
Mailing Address - Fax:828-626-2490
Practice Address - Street 1:540 DILLINGHAM RD
Practice Address - Street 2:
Practice Address - City:BARNARDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28709-9754
Practice Address - Country:US
Practice Address - Phone:828-626-2490
Practice Address - Fax:828-626-2490
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2763439Medicare ID - Type Unspecified
NCSMITHLAURIE0Medicare UPIN