Provider Demographics
NPI:1033558465
Name:SMITHERS, KRYSTAL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:
Last Name:SMITHERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1160
Mailing Address - Country:US
Mailing Address - Phone:304-343-4300
Mailing Address - Fax:304-343-5473
Practice Address - Street 1:208 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-1160
Practice Address - Country:US
Practice Address - Phone:304-343-4300
Practice Address - Fax:304-343-5473
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01725363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033558465OtherNPI