Provider Demographics
NPI:1982644134
Name:SMITH, NADYA ALEXANDRA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:NADYA
Middle Name:ALEXANDRA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NADYA
Other - Middle Name:
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1190 RIDDLE ST
Mailing Address - Street 2:PO BOX 390
Mailing Address - City:DARRINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98241
Mailing Address - Country:US
Mailing Address - Phone:360-436-1055
Mailing Address - Fax:
Practice Address - Street 1:1190 RIDDLE ST
Practice Address - Street 2:
Practice Address - City:DARRINGTON
Practice Address - State:WA
Practice Address - Zip Code:98241
Practice Address - Country:US
Practice Address - Phone:360-436-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8319246Medicaid
WAQ70533Medicare UPIN
WA508509Medicare Oscar/Certification
WA8319246Medicaid