Provider Demographics
NPI:1679073340
Name:SMITH, AMY BTH (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BTH
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RVT
Mailing Address - Street 1:611 CURRAN ST
Mailing Address - Street 2:
Mailing Address - City:DES ARC
Mailing Address - State:AR
Mailing Address - Zip Code:72040-3101
Mailing Address - Country:US
Mailing Address - Phone:870-830-5573
Mailing Address - Fax:
Practice Address - Street 1:2902 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4806
Practice Address - Country:US
Practice Address - Phone:501-268-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant