Provider Demographics
NPI:1225863210
Name:SMITH, KATHRYN ANSLEY (PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANSLEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:12427 JANES LNDG
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-2801
Mailing Address - Country:US
Mailing Address - Phone:248-935-1115
Mailing Address - Fax:
Practice Address - Street 1:12427 JANES LNDG
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-2801
Practice Address - Country:US
Practice Address - Phone:248-935-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant