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Individual
MS. MARYELLEN WARRO SMITH
Active
Individual
MS. MARYELLEN WARRO SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04930
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
337319301
—
TX
05
—
337319302
—
TX
05
—
337319303
—
TX
05
—
337319304
—
TX
01
—
75-0818167-015
TRICARE
TX
01
—
75-0818167-022
TRICARE
TX
01
—
75-0818167-044
TRICARE
TX
01
—
75-0818167-048
TRICARE
TX
01
—
75-1976930-005
TRICARE
TX
01
—
75-2616977-001
TRICARE
TX
01
—
75-2616977-002
TRICARE
TX
01
—
75-2616977-028
TRICARE
TX
01
—
8544ND
BCBS
TX
01
—
8545ND
BCBS
TX
01
—
8546ND
BCBS
TX
01
—
8547ND
BCBS
TX
Enumeration date
08/21/2006
Last updated
02/28/2018
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