Provider Demographics
NPI:1386394245
Name:SMITH, RACHEL ELOISE (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELOISE
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 1:6352 YELLOW RIVER RANCH RD
Mailing Address - Street 2:
Mailing Address - City:FLORALA
Mailing Address - State:AL
Mailing Address - Zip Code:36442-7408
Mailing Address - Country:US
Mailing Address - Phone:205-542-4315
Mailing Address - Fax:
Practice Address - Street 1:6352 YELLOW RIVER RANCH RD
Practice Address - Street 2:
Practice Address - City:FLORALA
Practice Address - State:AL
Practice Address - Zip Code:36442-7408
Practice Address - Country:US
Practice Address - Phone:205-542-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant