Provider Demographics
NPI:1750036406
Name:SMITH, ELIZABETH CLAIRE (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLAIRE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1301 PLEASANT VALLEY RD STE 404
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9774
Practice Address - Country:US
Practice Address - Phone:270-417-7515
Practice Address - Fax:270-417-7699
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2023-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYTC185363A00000X
KYPA3005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant