Provider Demographics
NPI:1730545476
Name:SMITH, HEATHERLY MORTON (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HEATHERLY
Middle Name:MORTON
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:23 SUNNYBROOK RD STE 316
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1874
Mailing Address - Country:US
Mailing Address - Phone:919-350-6002
Mailing Address - Fax:919-350-6003
Practice Address - Street 1:23 SUNNYBROOK RD STE 316
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1874
Practice Address - Country:US
Practice Address - Phone:919-350-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant