Provider Demographics
NPI:1952029217
Name:SMITH, CHRISTEN SAMIRA (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:SAMIRA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTEN
Other - Middle Name:SAMIRA
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:13029 SAVORY PL
Mailing Address - Street 2:
Mailing Address - City:SAINT HEDWIG
Mailing Address - State:TX
Mailing Address - Zip Code:78152-0524
Mailing Address - Country:US
Mailing Address - Phone:254-285-9018
Mailing Address - Fax:
Practice Address - Street 1:12881 N INTERSTATE 35
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2966
Practice Address - Country:US
Practice Address - Phone:210-742-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA18527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program