Provider Demographics
NPI:1790729739
Name:SMITHA, ANGELA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:SMITHA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 EASTERN BYP
Mailing Address - Street 2:MEDICAL BUILDING 2 SUITE 5
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2406
Mailing Address - Country:US
Mailing Address - Phone:859-624-2229
Mailing Address - Fax:
Practice Address - Street 1:795 EASTERN BYP
Practice Address - Street 2:MEDICAL BUILDING 2 SUITE 5
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2406
Practice Address - Country:US
Practice Address - Phone:859-624-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7771729OtherAETNA
KY000000215086OtherANTHEM BCBS
KY0707903Medicare PIN
KYR38239Medicare UPIN