Provider Demographics
NPI:1467655506
Name:SMITH, ALEIDA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:ALEIDA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:900 E BATTLEFIELD ST STE 124
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5208
Mailing Address - Country:US
Mailing Address - Phone:417-986-1289
Mailing Address - Fax:316-462-1040
Practice Address - Street 1:900 E BATTLEFIELD ST STE 124
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5208
Practice Address - Country:US
Practice Address - Phone:417-986-1289
Practice Address - Fax:316-462-1040
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2020-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00840363A00000X
MO2019003486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant