Provider Demographics
NPI:1851984041
Name:SMITH, JULIE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
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 1358
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-0014
Mailing Address - Country:US
Mailing Address - Phone:254-965-2663
Mailing Address - Fax:549-687-9792
Practice Address - Street 1:561 N GRAHAM ST UNIT 101
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3555
Practice Address - Country:US
Practice Address - Phone:254-965-2663
Practice Address - Fax:254-968-7979
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14329363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical