Provider Demographics
NPI:1689090433
Name:SMITH, ELIZABETH N (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:N
Last Name:SMITH
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 1:123 FRONTAGE ROAD A
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-6301
Mailing Address - Country:US
Mailing Address - Phone:985-580-1200
Mailing Address - Fax:
Practice Address - Street 1:123 FRONTAGE ROAD A
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-6301
Practice Address - Country:US
Practice Address - Phone:985-580-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant