Provider Demographics
NPI:1962754754
Name:SMITH, ZACHARY KENNETH EARL (PA-S)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:KENNETH EARL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-S
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 639982
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST STE 160
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5900
Practice Address - Country:US
Practice Address - Phone:419-996-5224
Practice Address - Fax:419-996-5276
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007066RX363A00000X
MI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No104100000XBehavioral Health & Social Service ProvidersSocial Worker