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Individual
TORI LANE SMITH
Active
Individual
TORI LANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15500
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962013185
—
TX
01
—
8SM356
BCBS PROVIDER ID
TX
Enumeration date
08/11/2020
Last updated
08/07/2024
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