Provider Demographics
NPI:1023500709
Name:SMITH, AVA (PA)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2900 E 29TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2623
Mailing Address - Country:US
Mailing Address - Phone:979-776-8440
Mailing Address - Fax:877-601-5854
Practice Address - Street 1:8441 STATE HIGHWAY 47 STE 1400
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-3208
Practice Address - Country:US
Practice Address - Phone:979-774-8200
Practice Address - Fax:877-601-5854
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2020-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA11972363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant