Provider Demographics
NPI:1114049723
Name:SMITH, CATHY ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 ERSHIG RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-9670
Mailing Address - Country:US
Mailing Address - Phone:360-766-7615
Mailing Address - Fax:
Practice Address - Street 1:700 S 2ND ST
Practice Address - Street 2:ROOM 301
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3879
Practice Address - Country:US
Practice Address - Phone:360-336-9380
Practice Address - Fax:360-336-9401
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001695363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA83-065-11Medicaid