Active NPI
Kenneth Eric Smoot, PA
- Physician Assistant
- Gainesville, FL
National Provider Identifier
1376689372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 003686
- Practice address
- 1601 SW Archer Rd
Gainesville, FL 32608-1135 - Phone
- (352) 376-1611
- Fax
- (352) 379-4015
- NPI assigned
- Jan 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 003686 | GA | Primary |
Addresses
Primary practice location
1601 SW Archer Rd
Gainesville, FL 32608-1135
Mailing address
1601 SW Archer Rd.
Gainesville, FL 32608
Phone (352) 376-1611
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003686 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269993600000",
"number": "1376689372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 SW ARCHER RD.",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "32608",
"telephone_number": "352-376-1611",
"fax_number": "352-379-4015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 SW ARCHER RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326081135",
"telephone_number": "352-376-1611",
"fax_number": "352-379-4015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMOOT",
"first_name": "KENNETH",
"middle_name": "ERIC",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2010-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "003686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.