Individual
MS. NICOLE K SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
40 V TWIN DR, STE 202, GETTYSBURG, PA 17325-1926
(717) 339-2710
(717) 339-2711
Mailing address
3421 CONCORD RD, YORK, PA 17402-9001
(717) 339-2710
(717) 339-2711
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA050968
PA
363AM0700X
Medical Physician Assistant
Primary
MA050968
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00549500
—
PA
01
—
1602843
GATEWAY MEDICARE ASSURED
PA
01
—
2566850
HIGHMARK BLUE SHIELD - FREEDOM BLUE
PA
01
—
MA05096A
DEPT OF STATE BUREAU OF P
PA
Enumeration date
11/09/2006
Last updated
03/07/2023
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