Provider Demographics
NPI:1982881181
Name:SMITH, DARRON TERRY (PHD, PA-C, DFAAPA)
Entity type:Individual
Prefix:DR
First Name:DARRON
Middle Name:TERRY
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD, PA-C, DFAAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 WALNUT KNOLL LN STE 101
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3112
Mailing Address - Country:US
Mailing Address - Phone:901-624-0100
Mailing Address - Fax:901-624-0778
Practice Address - Street 1:135 CARMEN LN
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-7729
Practice Address - Country:US
Practice Address - Phone:805-332-4568
Practice Address - Fax:800-417-9245
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT326942-1206363A00000X
TN2943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57494OtherPHYSICIAN ASSISTANT BOARD