Provider Demographics
NPI:1609209568
Name:SMART-COUNTS, TRISHA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:
Last Name:SMART-COUNTS
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 1:1040 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1226
Mailing Address - Country:US
Mailing Address - Phone:316-945-9400
Mailing Address - Fax:
Practice Address - Street 1:700 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9013
Practice Address - Country:US
Practice Address - Phone:316-630-0608
Practice Address - Fax:316-630-0564
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00502363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical