Provider Demographics
NPI:1750048609
Name:SMITH, SAVANNAH KATE
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:KATE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 ALCOTT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2947
Mailing Address - Country:US
Mailing Address - Phone:651-239-7343
Mailing Address - Fax:
Practice Address - Street 1:10375 PARK MEADOWS DR STE 270
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6760
Practice Address - Country:US
Practice Address - Phone:303-351-5995
Practice Address - Fax:720-925-5897
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant