| NPI | 1700424959 |
|---|---|
| Former Name | REBECCA SHANNON SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.1551) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-02567) |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2022-12-13 |