Provider Demographics
NPI:1649587023
Name:SMITH, SANDRA SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 PAR RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-1108
Mailing Address - Country:US
Mailing Address - Phone:580-336-1840
Mailing Address - Fax:
Practice Address - Street 1:535 6TH ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-2542
Practice Address - Country:US
Practice Address - Phone:918-762-3942
Practice Address - Fax:918-762-4675
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant