Provider Demographics
NPI:1407321680
Name:SMITH, ALYSSA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
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 1:5630 S WATERBURY WAY STE B102
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6209
Mailing Address - Country:US
Mailing Address - Phone:801-274-2000
Mailing Address - Fax:801-274-2000
Practice Address - Street 1:1160 E 3900 S STE 1200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1251
Practice Address - Country:US
Practice Address - Phone:801-261-9651
Practice Address - Fax:801-261-9656
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2022-02-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical