Individual
KELLY ELIZABETH SMYTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
183 N MOUNTAIN RD STE 207, NEW BRITAIN, CT 06053-4325
(860) 696-2040
(860) 696-2050
Mailing address
183 N MOUNTAIN RD STE 207, NEW BRITAIN, CT 06053-4325
(860) 696-2040
(860) 696-2050
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3654
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085.006397
IL PA LICENSE
IL
Enumeration date
08/19/2016
Last updated
04/26/2023
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