Basic Information
| Provider Information | |||||||||
| NPI: | 1578592648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMEHYL | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | SUSANNE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1006 W PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | AVON PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338252966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634533121 | ||||||||
| FaxNumber: | 8634522823 | ||||||||
| Practice Location | |||||||||
| Address1: | 1006 W PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | AVON PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338252966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634533121 | ||||||||
| FaxNumber: | 8634522823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 05/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA2897 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 290609100 | 05 | FL | MEDICAID | 970013283 | 01 | RAILROAD MEDICARE | OTHER |