Provider Demographics
NPI:1194788547
Name:SMITH, JANET LEE (PA)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:LEE
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WV
Mailing Address - Zip Code:26807-0100
Mailing Address - Country:US
Mailing Address - Phone:304-358-2355
Mailing Address - Fax:
Practice Address - Street 1:82 PINE ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807-6630
Practice Address - Country:US
Practice Address - Phone:304-358-2355
Practice Address - Fax:855-332-1388
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102993363A00000X
VA0110005314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194788547Medicaid
NCNC8682BMedicare UPIN
NC204843DMedicare PIN