Provider Demographics
NPI:1629217377
Name:SMITH, KAREN FELICIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:FELICIA
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 1:15340 DEVONSHIRE ST STE 8
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2760
Mailing Address - Country:US
Mailing Address - Phone:818-894-9411
Mailing Address - Fax:818-894-7611
Practice Address - Street 1:15340 DEVONSHIRE ST STE 8
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2760
Practice Address - Country:US
Practice Address - Phone:818-894-9411
Practice Address - Fax:818-894-7611
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10758363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical