Provider Demographics
NPI:1487609863
Name:SMITH-HARTNESS, JUNE DURELL (PA-C)
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:DURELL
Last Name:SMITH-HARTNESS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 HIGHWAY 16 N
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7814
Mailing Address - Country:US
Mailing Address - Phone:704-489-8911
Mailing Address - Fax:704-489-8912
Practice Address - Street 1:1420 HIGHWAY 16 N
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7814
Practice Address - Country:US
Practice Address - Phone:704-489-8911
Practice Address - Fax:704-489-8912
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100546363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS89038Medicare UPIN
NC2335801AMedicare PIN