Provider Demographics
NPI:1851916803
Name:SMITH, KENZIE HARLINE (PA-C)
Entity Type:Individual
Prefix:
First Name:KENZIE
Middle Name:HARLINE
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 1:1191 W PITCHFORK RD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-7672
Mailing Address - Country:US
Mailing Address - Phone:719-661-6348
Mailing Address - Fax:
Practice Address - Street 1:1191 W PITCHFORK RD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-7672
Practice Address - Country:US
Practice Address - Phone:719-661-6348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program