Individual
MS. AMY ANN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
550 SOUTHLAND DR, DECATUR, IL 62521-4080
(217) 425-9264
(217) 425-5983
Mailing address
2300 N EDWARD ST, GSBLL, DECATUR, IL 62526-4163
(217) 876-2857
(217) 876-2874
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005048
IL
363AM0700X
Medical Physician Assistant
085005048
IL
363AM0700X
Medical Physician Assistant
5214
AZ
Other
Enumeration date
10/12/2012
Last updated
01/13/2023
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