Provider Demographics
NPI:1982673695
Name:SMILDEN, RHAEJON M (PA-C)
Entity Type:Individual
Prefix:
First Name:RHAEJON
Middle Name:M
Last Name:SMILDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:12410 E SINTO AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2280
Practice Address - Country:US
Practice Address - Phone:509-344-2663
Practice Address - Fax:509-624-9179
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2837SMOtherASURIS NW HEALTH
WA8940174OtherCRIME VICTIMS
WA0202788OtherDEPT OF LABOR & INDUSTRIE
IDK6427OtherBLUE CROSS OF IDAHO
WAP00272445OtherRR MEDICARE
WA8375271Medicaid
IDK6427OtherBLUE CROSS OF IDAHO
WA2837SMOtherASURIS NW HEALTH