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Individual

HEATHER L SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
2003 STULTS RD STE 210, HUNTINGTON, IN 46750-1291
(260) 355-3110
(260) 355-3114
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001127A
IN
363A00000X
Physician Assistant
3023
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000633571
ANTHEM
IN
05
918328
AZ
Enumeration date
08/24/2005
Last updated
11/15/2022
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