Individual
MRS. CAREN J SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
765 S UTAH AVE, IDAHO FALLS, ID 83402-5093
(208) 525-2600
(208) 525-2611
Mailing address
765 S UTAH AVE, IDAHO FALLS, ID 83402-5093
(208) 525-2600
(208) 525-2611
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-647
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16681774
MEDICARE PTAN
ID
Enumeration date
12/15/2006
Last updated
01/26/2010
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