Provider Demographics
NPI:1356424782
Name:SMITH, ANGELA M (PA)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2409
Mailing Address - Fax:970-490-4155
Practice Address - Street 1:5589 ARGONNE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8989
Practice Address - Country:US
Practice Address - Phone:720-516-8805
Practice Address - Fax:720-516-8806
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2025-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01458363A00000X
AK917363A00000X
CO1736363A00000X, 363AM0700X
WAPA60636968363A00000X
COPA.0001736363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05338735Medicaid
Q11063Medicare UPIN
COCO304599Medicare PIN