Provider Demographics
NPI:1518361054
Name:SMATHERS, STACY (PA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SMATHERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EMERY STREET
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2401
Mailing Address - Country:US
Mailing Address - Phone:940-484-4424
Mailing Address - Fax:940-243-1431
Practice Address - Street 1:2000 EMERY STREET
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2401
Practice Address - Country:US
Practice Address - Phone:940-484-4424
Practice Address - Fax:940-243-1431
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant