Provider Demographics
NPI:1184482739
Name:SMITH, AUBREY MADISON (PA)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:MADISON
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:MADISON
Other - Last Name:YOUNGBLOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1816 BOBBITT LN
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-9544
Mailing Address - Country:US
Mailing Address - Phone:870-648-5376
Mailing Address - Fax:
Practice Address - Street 1:1816 BOBBITT LN
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-9544
Practice Address - Country:US
Practice Address - Phone:870-648-5376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant