Individual
STACEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 TUCKER AVE NE, ALBUQUERQUE, NM 87131-0001
(505) 272-1734
(505) 272-1736
Mailing address
933 BRADBURY DR SE, SUITE 2222, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA20030041
NM
Other
Enumeration date
11/22/2005
Last updated
06/22/2023
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