Provider Demographics
NPI:1346932134
Name:SMITH, SAMANTHA KAY (PA)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10046 WHITE OAK PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-4671
Mailing Address - Country:US
Mailing Address - Phone:252-474-6299
Mailing Address - Fax:
Practice Address - Street 1:5600 S QUEBEC ST # A
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2207
Practice Address - Country:US
Practice Address - Phone:303-306-7783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008958363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant