Provider Demographics
NPI:1750970497
Name:SMITH, BRITTANY LYNNE (PA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SPAULDING ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01469-1114
Mailing Address - Country:US
Mailing Address - Phone:978-809-5668
Mailing Address - Fax:
Practice Address - Street 1:784 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2549
Practice Address - Country:US
Practice Address - Phone:603-742-5556
Practice Address - Fax:603-742-8668
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MAPA8568363A00000X
MA390200000X
NH2864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program