Provider Demographics
NPI:1205200227
Name:SMITH, LAURA DANIELLE (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DANIELLE
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 1:1725 BIRMINGHAM RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4064
Mailing Address - Country:US
Mailing Address - Phone:979-696-8000
Mailing Address - Fax:979-696-8100
Practice Address - Street 1:1725 BIRMINGHAM RD STE 200
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4064
Practice Address - Country:US
Practice Address - Phone:979-696-8000
Practice Address - Fax:979-696-8100
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant