Provider Demographics
NPI:1285208488
Name:SMITH, ELIZABETH THOMPSON (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:THOMPSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5826 FAYETTEVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8684
Mailing Address - Country:US
Mailing Address - Phone:980-355-4926
Mailing Address - Fax:919-914-0942
Practice Address - Street 1:5826 FAYETTEVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8684
Practice Address - Country:US
Practice Address - Phone:919-246-5611
Practice Address - Fax:919-914-0942
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-11297363AM0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical