Provider Demographics
NPI:1215694799
Name:SMITH, AMBERLY JOY (PA-C)
Entity type:Individual
Prefix:
First Name:AMBERLY
Middle Name:JOY
Last Name:SMITH
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:PO BOX 40954
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-0169
Mailing Address - Country:US
Mailing Address - Phone:970-581-1740
Mailing Address - Fax:
Practice Address - Street 1:1077 GATEWAY LOOP
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1114
Practice Address - Country:US
Practice Address - Phone:541-485-6478
Practice Address - Fax:541-868-9606
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA207901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant