Individual
JILL ELAINE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
910 E HOUSTON ST STE 100, TYLER, TX 75702-8363
(903) 579-9800
(903) 526-4463
Mailing address
PO BOX 911230, DALLAS, TX 75391-1242
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA12144
TX
363AM0700X
Medical Physician Assistant
PA12144
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
401094403
—
TX
Enumeration date
08/30/2018
Last updated
11/09/2021
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