Provider Demographics
NPI:1396033395
Name:SMITH, ERIK KRISTOPHER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:KRISTOPHER
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIK
Other - Middle Name:K
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:729 SUNRISE AVE
Mailing Address - Street 2:STE 602
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4542
Mailing Address - Country:US
Mailing Address - Phone:916-953-7571
Mailing Address - Fax:916-771-8515
Practice Address - Street 1:5255 ELKHORN BLVD STE C
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95842
Practice Address - Country:US
Practice Address - Phone:916-334-1100
Practice Address - Fax:916-334-1105
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21692363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant