Provider Demographics
NPI:1497476048
Name:SMITH, COURTNEY THERESE (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:THERESE
Last Name:SMITH
Suffix:
Gender:F
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 1:2625 BOX CANYON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0450
Mailing Address - Country:US
Mailing Address - Phone:702-360-6100
Mailing Address - Fax:702-360-8096
Practice Address - Street 1:2625 BOX CANYON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0450
Practice Address - Country:US
Practice Address - Phone:702-360-6100
Practice Address - Fax:702-360-8096
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant