Katrina J Smith, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9105946 Issued in FL

Practice address

4215 Edgewater Dr
Orlando, FL 32804-2206

Phone

(973) 826-8080

Fax

(888) 972-6480

NPI assigned

Apr 13, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeastern Clinical Services,Inc.

  • Surgical Physician Assistant
  • Orlando, FL
  • NPI 1033162011
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1689964462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4059",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074744059",
            "telephone_number": "973-826-8080",
            "fax_number": "888-972-6480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 EDGEWATER DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328042206",
            "telephone_number": "973-826-8080",
            "fax_number": "888-972-6480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KATRINA",
        "middle_name": "J",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-13",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9105946",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QSS SCS PTAN",
            "identifier": "FB469U",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaala Monique Smith
• Kaden Robert Smith
• Kailee Smith, M.D.
• Katelyn Smith, PA-C
• Katherine Joan Smith, ARNP
• Katy Patricia Smith, MA
• Kearney Coleen Smith, RCSWI
• Kelece Smith, MA OF PSYCHOLOGY
• Kellee Smith
• Kellie Welch Smith, AUD

• Surgical Physician Assistant in Orlando, FL
• Providers in Orlando, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.