Provider Demographics
NPI:1841420122
Name:SMITH, ROBIN JOY (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:JOY
Last Name:SMITH
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 1:21906 NE 150TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-7292
Mailing Address - Country:US
Mailing Address - Phone:860-992-9150
Mailing Address - Fax:
Practice Address - Street 1:9709 3RD AVE NE
Practice Address - Street 2:SUITE 309
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-729-7315
Practice Address - Fax:866-895-7142
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60521692363A00000X
CT002276363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002276OtherSTATE LICENSE
WAPA60521692OtherWA STATE