Provider Demographics
NPI:1073058491
Name:SMITH, COURTNEY HOLLY (PA)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:HOLLY
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:500 CAMPUS DR
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1452
Mailing Address - Country:US
Mailing Address - Phone:906-483-1000
Mailing Address - Fax:
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1452
Practice Address - Country:US
Practice Address - Phone:906-483-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008042363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant