Provider Demographics
NPI:1578592648
Name:SMEHYL, KATHY SUSANNE (PA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:SUSANNE
Last Name:SMEHYL
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 1:1006 W PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2966
Mailing Address - Country:US
Mailing Address - Phone:863-453-3121
Mailing Address - Fax:863-452-2823
Practice Address - Street 1:1006 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2966
Practice Address - Country:US
Practice Address - Phone:863-453-3121
Practice Address - Fax:863-452-2823
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2897363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290609100Medicaid
970013283OtherRAILROAD MEDICARE
FLE1461XMedicare UPIN
FL290609100Medicaid
970013283OtherRAILROAD MEDICARE
S66045Medicare UPIN