Provider Demographics
NPI:1053518340
Name:SMITH, KATHRYN COMARDA (PA-C)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:COMARDA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD SUITE 103
Mailing Address - Street 2:PEDIATRIC HOSPITALISTS OF LA
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808
Mailing Address - Country:US
Mailing Address - Phone:225-767-6700
Mailing Address - Fax:225-767-6721
Practice Address - Street 1:7777 HENNESSY BLVD SUITE 103
Practice Address - Street 2:PEDIATRIC HOSPITALISTS OF LA
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-767-6700
Practice Address - Fax:225-767-6721
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200099363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1369594Medicaid