Provider Demographics
NPI:1053387464
Name:SMITH, KAREN SUE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:140 COLEMANS XING STE 200
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7195
Mailing Address - Country:US
Mailing Address - Phone:937-578-4300
Mailing Address - Fax:937-578-4311
Practice Address - Street 1:140 COLEMANS XING STE 200
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7195
Practice Address - Country:US
Practice Address - Phone:937-578-4300
Practice Address - Fax:937-578-4311
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2745363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHPA31571Medicare PIN