Provider Demographics
NPI:1225411291
Name:SMITH, LINCOLN STEPHEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LINCOLN
Middle Name:STEPHEN
Last Name:SMITH
Suffix:
Gender:M
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 1:4550 FAUNTLEROY WAY SW STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3471
Mailing Address - Country:US
Mailing Address - Phone:206-933-1041
Mailing Address - Fax:
Practice Address - Street 1:4550 FAUNTLEROY WAY SW STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3471
Practice Address - Country:US
Practice Address - Phone:206-933-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60577633363AM0700X
WAOA61063409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA60577633OtherWASHINGTON STATE PA LICENSE
WA2048671Medicaid