Provider Demographics
NPI:1700572609
Name:SMITH, LAUREN NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4729 CRAIGMOSS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6676
Mailing Address - Country:US
Mailing Address - Phone:757-409-0385
Mailing Address - Fax:
Practice Address - Street 1:10700 SIKES PL STE 325
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8208
Practice Address - Country:US
Practice Address - Phone:704-247-7353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical